Costs Lower, Switching Higher with Oral Immunotherapy for Inflammatory Joint, Skin Disease

Patients who used oral immunotherapies for chronic inflammatory joint and skin diseases were more likely to switch medications than those who used injectable immunotherapies, but total healthcare costs were lower with oral therapies, according to a study published in the Journal of Managed Care & Specialty Pharmacy. 

“This is the first population-level study at a route-of-administration level, which compared switching, health care resource utilization, and costs across several conditions,” wrote researchers from Humana.

The retrospective observational study used claims data from a large US health plan to identify 6525 adults with rheumatoid arthritis, psoriatic arthritis, and psoriasis starting oral and injectable immunotherapy. The study followed the patients for 12 months after their first claim for an oral or injectable medication. 

Switching immunotherapies was more common in the oral group, specifically among patients with skin conditions and joint and skin conditions, compared with the injectable group. The finding could indicate lower effectiveness or tolerability of oral compared with injectable immunotherapies, researchers wrote. Discontinuation rates, however, did not differ between the two routes of administration.  

The study found mixed outcomes regarding healthcare resource utilization. Outpatient and physician office visits were significantly higher among patients taking oral immunotherapies, but inpatient stays did not differ between the oral and injectable groups. Pharmacy costs were lower with oral immunotherapies, but medical costs were higher. Still, total healthcare costs were lower for the oral group. 

“This real-world comparative study found that patients initiating oral immunotherapy in the treatment of rheumatoid arthritis, psoriatic arthritis, and psoriasis were more likely to switch medications and have increased outpatient healthcare encounters relative to patients initiating injectable immunotherapies,” researchers concluded. “Oral immunotherapy, however, was considerably less costly, which may be an essential consideration for treating patients who respond well to oral therapies.” 

—Jolynn Tumolo 

Reference 

Bhattacharya R, Herren K, Poonawalla I, Bunniran S, Bloomfield A, Schwab P. Comparing medical utilization and cost outcomes in oral versus injectable immunotherapy users with chronic inflammatory joint and skin diseases. Journal of Managed Care & Specialty Pharmacy. 2020;26(10):1246-1256.