Real-World Experience With Apremilast In The Treatment Of Adults With Moderate To Severe Plaque Psoriasis In Quebec: A Claims-Based Analysis Of Drug Utilization And Healthcare Resource Utilization

Background In Quebec, targeted biologic therapies for moderate to severe plaque psoriasis are restricted to patients who have not responded to phototherapy or conventional systemic treatment, primarily due to high drug costs. Apremilast, an oral treatment for plaque psoriasis, was added to the Quebec provincial health insurance plan (Regie de l'assurance maladie du Quebec; RAMQ) formulary in 2015, making this the only province in Canada with public drug plan reimbursement for apremilast. Objectives The aim of this study is to describe patients' characteristics, treatment patterns, healthcare resource utilization (HCRU), and associated costs and to measure real-world budget impact of using apremilast before biologics in plaque psoriasis. Methods This study was performed using RAMQ drug claims and medical services data. Patients diagnosed with psoriasis between January 2015 and December 2017 were identified. Medical services and prescription claims were categorized as all-cause and psoriasis-related. Using RAMQ database estimates, a 3-year budget impact analysis was developed comparing treatment cost with and without the addition of apremilast to the formulary. Results In all, 540 patients were identified (apremilast:n= 92; biologics:n= 448). Comorbidity burden and treatment persistence and adherence were comparable between apremilast and biologic users. The year following the index date, all-cause HCRU was lower for apremilast versus biologic users (CAN$19 763 vs CAN$28 025;P< .01), mainly driven by drug cost. Using apremilast before biologics resulted in an estimated RAMQ net savings of CAN$49 290 (2015), CAN$746 856 (2016), and CAN$1 216 512 (2017), and a total savings of CAN$2 012 658 since apremilast's addition to the formulary. Conclusion Adding apremilast to the drug formulary of other Canadian provinces could result in significant healthcare savings.