Psoriatic arthritis (PsA) is a clinically heterogenous disease with significant diagnostic and treatment challenges, which vary largely by different health care providers. A new analysis, whose findings were presented at the American College of Rheumatology/Empowering Rheumatology Professionals Annual Meeting, evaluated outcomes for PsA patients associated with differences in clinical practice between physician specialties.
Administrative claims data spanning 2014–2017 were collected from the IBM MarketScan commercial and supplemental Medicare databases. Newly diagnosed PsA patients aged >18 years were included in the study if they were continuously enrolled in their plan 12 months prior to and following their index diagnosis date; did not have infectious disease, cancer, or any other autoimmune disease other than psoriasis; and did not receive any pharmacologic treatments indicated for PsA prior to the index diagnosis date. Patients who received medical treatment indicated for PsA were stratified by physician specialty based on the 30-day period prior to the earliest medication claim. Patients who were not treated within 90 days from their diagnosis were assigned to the specialist who provided the index diagnosis. Primary outcomes over one year included medication utilization (including switching rates) and health care expenditures.
The final analysis included 3,520 patients (average age, 49.7 years; 56% were female). Among patients assigned to rheumatologists, 65% received early pharmacologic treatment, compared to 46% of dermatologists’ patients. Of patients who received PsA medication, more than half (55%) were prescribed by a rheumatologist, 8% by a dermatologist, <1% by combination of both, 13% by a primary care provider, and 24% by others (e.g., pain management, physical medicine & rehab, etc.). Dermatologists were the most likely to prescribe a tumor necrosis factor inhibitor (73%). Significant variances were observed in mean total annual prescription and health care expenditures, and while rheumatologists had lower prescription costs than dermatologists, patients assigned to both groups incurred similar overall costs.
“While more research is needed to confirm the findings, they highlight potential differences between rheumatologists and other physicians in managing costs and adherence to the recommended clinical guidelines for the management of PSA,” the researchers concluded.