Trajectories of systemic agent use and associated depression- and anxiety-related health care costs among patients with psoriasis

Raymond Milan; Jacques LeLorier; Eric A Latimer; Marie-Josée Brouillette; Anne Holbrook; Ivan V Litvinov; Elham Rahme

doi:10.1016/j.jdin.2022.06.018

Trajectories of systemic agent use and associated depression- and anxiety-related health care costs among patients with psoriasis

JAAD Int. 2022 Jun 25:9:11-22. doi: 10.1016/j.jdin.2022.06.018. eCollection 2022 Dec.

Authors

Raymond Milan^{1

2}, Jacques LeLorier^{3

4}, Eric A Latimer^{5

6}, Marie-Josée Brouillette^{2

5}, Anne Holbrook^{7

8

9}, Ivan V Litvinov^{10

11}, Elham Rahme^{2

12}

Affiliations

¹ Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada.
² Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.
³ Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada.
⁴ Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
⁵ Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
⁶ Douglas Mental Health University Institute, Montréal, Quebec, Canada.
⁷ Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁹ Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
¹⁰ Division of Dermatology, Department of Medicine, McGill University, Montréal, Quebec, Canada.
¹¹ Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.
¹² Division of Clinical Epidemiology, Department of Medicine, McGill University, Montréal, Quebec, Canada.

Abstract

Background: Systemic treatment patterns and related mental health disorders and economic burden among patients with psoriasis are largely unknown.

Objective: To assess systemic treatment patterns and associated depression and anxiety-related health care costs among patients with psoriasis initiating a conventional systemic treatment (CST).

Methods: Using a retrospective cohort design with sequence and cluster analyses, we assessed systemic treatment trajectories (CST and tumor necrosis factor inhibitors or ustekinumab, [TNFi/UST]) over a 2-year period following CST initiation. We compared health care costs between trajectories using 2-part models.

Results: We included 781 patients and identified 8 trajectories: persistent methotrexate users, persistent acitretin users, early CST discontinuation, late methotrexate discontinuation, switch to TNFi/UST, adding TNFi/UST, discontinuation then restart on methotrexate, and discontinuation then restart on acitretin or multiple CST switches. Overall, 165 (21%) patients incurred depression- and anxiety-related health care costs (median annual cost, CAN$56; quartiles, $14-$127). Compared with persistent methotrexate users, adding a TNFi/UST (cost ratio, 3.63; 95% CI, 1.47-5.97) and discontinuation then restart on acitretin or multiple switches between systemic agents (cost ratio, 13.3; 95% CI 5.76-22.47) had higher costs.

Limitations: Trajectory misclassification may have occured. These date represent an association, and causality cannot be inferred, particularly given the risk of confounding.

Conclusion: Depression- and anxiety-related health care costs were high among patients adding TNFi/UST and those discontinuing then restarting on acitretin or experiencing multiple switches between systemic agents.

Keywords: AHCA, agglomerative hierarchical cluster analysis; CST, conventional systemic therapy; ED, emergency department; ICD, International Classification of Diseases; SA, sequence analysis; TNFi/UST, Tumor necrosis factor inhibitors and ustekinumab; anxiety; depression; health care costs; psoriasis; systemic agents; trajectories.