Adalimumab More Effective, Less Costly than Etanercept

New Orleans—An analysis of adult patients with moderate-to-severe psoriasis found that those treated with adalimumab had significantly fewer medical services and significantly lower pharmacy costs and medical services costs compared with those who received etanercept. The etanercept group also was significantly more likely to have the drug dose escalated. The poster, titled Resource Utilization and Costs Associated with Adalimumab or Etanercept for Moderate to Severe Psoriasis in a Real-World Setting, was presented at the AAD meeting. The authors used the Ingenix Impact National Managed Care database to select patients who had moderate-to-severe psoriasis, which was defined as having ≥1 conventional systematic therapy during the baseline period. Participants must have had a biologic prescription for adalimumab or etanercept after January 18, 2008. The authors considered the baseline period as 6 months before the index date and the study period as the 6 months following the index date. There were 419 patients in the etanercept group and 373 patients in the adalimumab cohort; the demographics for the 2 groups were similar. Compared with the etanercept group, patients taking adalimumab had fewer outpatient visits (10.17 visits per patient per month vs 12.13 visits; P=.0174), were more likely to have psoriatic arthritis (45.0% of patients vs 35.3%; P=.0053), and took more immunosuppressive agents (77.2% of patients vs 69.5%; P=.0139) and fewer antilipemic agents (15.0% of patients vs 21.7%; P=.0154). The authors found that the etanercept group received more emergency care compared with the adalimumab group (0.33 events per patient per 6 months vs 0.24 events; P=.0047) as well as more visits to the emergency department (0.27 events per patient per 6 months vs 0.20 events; P=.0204). Patients taking etanercept had more medical service as well (9.82 events per patient per 6 months vs 8.75 events; P=.0335). In addition, the 6-month healthcare costs for the etanercept group were significantly higher than for the adalimumab group ($14,670 per patient vs $11,376 per patient; P<.0001). The main reasons for the higher cost were that the average 6-month, per-patient inpatient cost for the etanercept group was $1209 higher and the average cost per patient of taking etanercept was $1915 higher than the cost of taking adalimumab. The 6-month pharmacy costs were also higher for patients taking etanercept ($11,104 per patient vs $861 per patient; P<.0001). A Cox proportional hazards analysis indicated that patients in the etanercept group had a 67% significantly higher risk at 6 months of having their dose increased (adjusted hazard ratio, 1.67; 95% confidence interval, 1.03-2.72; P=.0393). The authors defined dose escalation in the etanercept group as consecutive weekly doses greater than the induction dose during the 3-month induction period or consecutive weekly doses greater than the previous dose after the induction period. They only included patients with an induction dose of 50 mg or 100 mg and defined a dose escalation as a weekly etanercept dose >50 mg. For the adalimumab group, dose escalation was defined as consecutive weekly doses greater than the previous week’s dose. The authors cited some limitations to the study. The analysis could not account for indirect costs related to the biologics. In addition, the authors said claims data analysis has potential issues such as miscoding, but they said that both cohorts were similarly affected.