A Personalized Approach to Disease Management in Psoriasis - Episode 9

Leveraging Real-World Data at Emory Healthcare

Ryan Haumschild, PharmD, MS, MBA discusses the potential to lower total costs through care pathways designed to start patients with plaque psoriasis and metabolic syndrome on treatments that have shown to have better overall outcomes, such as tildrakizumab.

Ryan Haumschild, PharmD, MS, MBA: Well, I want to talk with you all really about innovative ways that we're leveraging real-world data to support personalized care. And I think personalized care has been kind of a hot topic recently, especially as we've talked about forever, making sure we're inclusive to all patient population types and especially in patient populations that don't respond well to therapy. Over time we see higher cost of care, poorer outcomes and reduce patient reported outcomes and quality of life. And so, that's something as an integrated delivery network across the country as payer arms, really need to start to consider. That's something that's really risen to the top for us. When we think about a specific disease state like plaque psoriasis, there's a number of agents in the space. And it's really easy sometimes to focus in on how are the patients doing, what's some of the major treatment that we want to consider, what should be our technical payer coverage for some select agents and how do we streamline our selection. Because at the end of the day, we're always trying to do what's best on behalf of the patients and the employer group and total cost of care considerations.

One of the things that we've looked at as we've started to look a little bit deeper into this, is we’ve found there's a stronger link between metabolic syndrome and plaque psoriasis. If we look back to some of the primary literature that's initiated this hypothesis, it's really come from the US, but really also in the European world in terms of dermatology, where they've seen a strong linking in terms of scores and dermatological responses for patients that have metabolic syndrome. And they seem kind of disparate differences in responses across patient populations. So, you not only want to consider that, but as we look at the payer arm, we also want to consider what's the cost of care. If we have patients, as we talked about earlier in this session that are switching between agents, that's really a unique consideration that we want to think about. We talked about some downsides to switching, especially in patients with metabolic syndrome is they may be less likely to go ahead and fill that medication, less likely to be supportive and continue to taking new medications. There's also the re-education on the medication. And this all plays a role.

I think in addition to that, as we start to switch these patients, there's a reinduction period that Dr. Lebwohl talked about. Really, when we think about that reinduction period, it's also causing a higher cost of care over the continuum of that patient population. If we have patients that might be more difficult to treat, with metabolic syndrome how do we identify a more accurate medication on the front end to make sure that we're getting the best outcomes right away, instead of having them transition from maybe 2 to 3 therapies before we ultimately pick the right choice. One of the ways that we really want to analyze that data and kind of do a deeper dive is how do we leverage our electronic medical record data, our specialty pharmacy data to see how patients are doing. I think through that probe, we were able to identify that there is a higher cost of care in patients that have metabolic syndrome as a comorbidity with plaque psoriasis. That hypothesis is something that we've definitely recognized.

We want to dig deeper to think about, not only do we want to know about it, we might have preferred products, but we may look at some medications that treat metabolic syndrome well, and plaque psoriasis that may not be the preferred product overall. And so, how do we focus in on creating care pathways so we're able to get the right medication to that patient sooner instead of having them step through different therapies or reinitiate several different therapies upon failure to finally get there? And I think that's kind of a key consideration that we're looking at, especially in this plaque psoriasis patient population. And we look at some of the resurface data, and we look at tildrakizumab, and we look at some of these different clinical indicators, we find that there is data that's starting to emerge that says, hey, if your patient population starts on this therapy sooner, they're going to have better overall outcomes. And if they have better overall outcomes, you're going to have probably a decreased total cost of care and you're not going to have to initiate several different medications throughout the process or biologics causing a higher cost of care.
When we looked at tildrakizumab, we found that that really looks appropriate. How do we create a pathway for that medication to see in real world if we're creating better access to this drug earlier on in therapy, are we seeing a reduction in care? Are we seeing better control of disease? Are we seeing better control of some of these comorbidities like Dr. Shaw mentioned earlier with some of this quality-of-life data in terms of arthritis and some of these other things that tend to populate within this patient population? So, those are the things that we're trying to think through and how we evaluate a unique pathway on the payer arm, also protocols on the healthcare side that would align together to really improve overall care for the patient population.

So, as we see this continue to grow, and we continue to look at some of these unique patient populations in oncology and plaque psoriasis and rheumatology, this is kind of where we think the forefront of research and patient treatment is going, and that’s having more of a personalized approach while still considering cost, but a more personalized approach having qualifying data there, maybe of 2 ICD-10 codes that indicate metabolic syndrome and plaque psoriasis. And that maybe being a pre-qualifier for earlier access, earlier treatment and ultimately, more specific, better patient care.

Transcripts edited for clarity.