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Impact of Biologics Use on Depression and Anxiety Frequency and Health Care Resource Utilization In Psoriasis: An Analysis Using the Quebec Provincial Drug Reimbursement Program Database

      Objectives

      Psoriasis is a chronic inflammatory disease of the skin that cannot be cured. For patients with active moderate to severe psoriasis, biologics use is associated with an improvement in patients’ quality of life especially by reducing prevalence of psychological disorders. The objective of this study was to assess the impact of biologics use on depression and anxiety frequency and the number of medical visits.

      Methods

      A retrospective study of the Quebec provincial drug reimbursement program (RAMQ) database was conducted using a randomly selected group of patients who have received at least one diagnosis of psoriasis between January 1st, 2007 and June 30th, 2012. To assess the impact of biologics use, time series analyses were performed. Time series analyses evaluate changes in the slope of a trend pre- and post-intervention, herein defined as biologics initiation. Trends in depression and anxiety frequency and medical visits frequency were compared for each year for a 5-year period before and after biologics initiation to assess the differences in slopes.

      Results

      A total of 43,400 patients with psoriasis were included in the study (mean age=54.6 [SD=21.9] years, 53.7% females), of which 1,108 (2.6%) used a biologic agent. For patients who needed to be treated with biologics, the rates of change in the depression and anxiety prevalence increased by 3.4% and by 4.2% per year prior to biologics initiation respectively. After biologics initiation, the trends were still increasing, but at a statistically lower rate of 2.5% (p=0.028) and of 2.4% (p=0.012) per year. Medical visits per patient increased during the 5-year period before biologics initiation. Visits frequency has reduced during the 5-year period after biologics initiation with a trend decreasing annually (p=0.002).

      Conclusions

      The present analysis illustrates that biologics use reduces the increase in depression and anxiety frequency and decreases the number of medical visits.