Table IV.
Odds of discontinuation in Medicare beneficiaries receiving biologics for psoriasis
| Discontinuation (90 d)
|
|||
|---|---|---|---|
| Odds ratio | 95% CI | P value | |
| Age category, y | |||
| <65 | 1.37 | 1.06–1.77 | .015 |
| 65–69 | Ref | ||
| 70–74 | 1.23 | 0.95–1.60 | .120 |
| 75–79 | 1.52 | 1.09–2.11 | .013 |
| ≥80 | 1.49 | 1.05–2.10 | .024 |
| Sex, male | 0.73 | 0.62–0.86 | <.001 |
| Race | |||
| White | Ref | ||
| Black | 1.11 | 0.80–1.55 | .525 |
| Hispanic | 0.80 | 0.51–1.25 | .326 |
| Other/unknown | 1.02 | 0.71–1.47 | .911 |
| Census region | |||
| Northeast | Ref | ||
| Midwest | 0.66 | 0.50–0.86 | .002 |
| South | 0.89 | 0.69–1.14 | .353 |
| West | 0.79 | 0.59–1.04 | .088 |
| County-level characteristics | |||
| Income, per capita, $10,000s | 0.95 | 0.85–1.06 | .333 |
| Dermatologists/10,000 residents | 1.15 | 0.81–1.62 | .437 |
| Low-income subsidy status | |||
| Full | Ref | ||
| Partial | 2.09 | 1.11–3.93 | .023 |
| None | 1.96 | 1.51–2.55 | <.001 |
| Mixed (switched status) | 4.29 | 1.94–9.48 | <.001 |
| Drug benefit type | |||
| Enhanced alternative | Ref | ||
| Basic alternative | 0.98 | 0.77–1.24 | .839 |
| Defined standard benefit | 0.86 | 0.60–1.23 | .402 |
| Actuarially equivalent standard | 1.12 | 0.85–1.47 | .436 |
| Unknown | 0.93 | 0.59–1.44 | .733 |
| Comorbidities | |||
| Rheumatologic disease | 1.06 | 0.59–1.90 | .859 |
| Congestive heart failure | 1.00 | 0.74–1.37 | .990 |
| Diabetes | 1.06 | 0.88–1.28 | .572 |
| Dyslipidemia | 0.93 | 0.78–1.10 | .384 |
| Hypertension | 0.98 | 0.82–1.18 | .851 |
| Obesity | 1.08 | 0.84–1.38 | .570 |
| Atherosclerotic conditions | 1.28 | 1.02–1.61 | .033 |
| Liver disease | 1.27 | 0.94–1.72 | .120 |
| Dementia | 1.56 | 0.70–3.48 | .276 |
| Depression | 1.20 | 0.97–1.49 | .100 |
| Psoriatic arthritis | 0.83 | 0.68–1.01 | .066 |
| Renal disease | 0.93 | 0.69–1.25 | .610 |
| Immunosuppressive conditions | 1.15 | 0.81–1.63 | .430 |
| No. of 30-d supply equivalent prescriptions for nonpsoriasis medications | 0.97 | 0.94–1.00 | .020 |
| RxHCC score, mean | 1.14 | 0.95–1.37 | .159 |
| Index year | |||
| 2010 | Ref | ||
| 2011 | 1.10 | 0.94–1.28 | .258 |
| Index biologic | |||
| Etanercept | 2.18 | 1.64–2.90 | <.001 |
| Infliximab | 1.41 | 0.99–2.02 | .060 |
| Ustekinumab | Ref | ||
| Adalimumab | 1.60 | 1.20–2.13 | .001 |
Rheumatologic disease category excludes rheumatoid arthritis. Atherosclerotic conditions category includes cerebrovascular disease, myocardial infarction, and peripheral vascular disease. Immunosuppressive conditions include HIV/AIDS, cancer, and metastatic solid tumor.
CI, Confidence interval; Ref, reference group; RxHCC, prescription drug hierarchical condition category.