Real-world psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database

J Med Econ. 2025 Dec;28(1):207-220. doi: 10.1080/13696998.2025.2452054. Epub 2025 Jan 21.

Abstract

Background: Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.

Objectives: This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.

Methods: The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.

Results: In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (n = 101) received index drug apremilast, 10.2% (n = 287) anti-IL, 6.8% (n = 191) anti-TNF, and 79.4% (n = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast vs. anti-IL and anti-TNF groups (24.8% vs. 59.6% and 53.9%; 36.6% vs. 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast vs. anti-IL and anti-TNF groups (4.95% vs. 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% vs. 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics vs. apremilast, respectively, and the main driver for lower overall apremilast costs.

Conclusion: Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.

Keywords: Anti-IL-17; I; I1; I10; I11; anti-IL-23; anti-TNF; apremilast; biologics; healthcare resource utilization; psoriasis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / economics
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Biological Products* / economics
  • Biological Products* / therapeutic use
  • Cost of Illness
  • Female
  • Germany
  • Humans
  • Incidence
  • Insurance Claim Review*
  • Male
  • Medication Adherence
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Prevalence
  • Psoriasis* / drug therapy
  • Retrospective Studies
  • Severity of Illness Index
  • Thalidomide* / analogs & derivatives
  • Thalidomide* / economics
  • Thalidomide* / therapeutic use
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • apremilast
  • Thalidomide
  • Biological Products
  • Tumor Necrosis Factor-alpha
  • Anti-Inflammatory Agents, Non-Steroidal