Eichenfield Lawrence F, DiBonaventura Marco, Xenakis Jason, Lafeuille Marie-Helene, Duh Mei Sheng, Fakih Iman, Levenberg Mark, Cappelleri Joseph C, Sikirica Vanja
Department of Dermatology and Pediatrics, UC San Diego, San Diego, CA, USA.
Rady Children's Hospital, San Diego, San Diego, CA, USA.
Dermatol Ther (Heidelb). 2020 Aug;10(4):791-806. doi: 10.1007/s13555-020-00413-8. Epub 2020 Jun 30.
For many, atopic dermatitis (AD) is not adequately controlled with topical regimens. This analysis examined treatment using advanced therapies and associated costs.
The IQVIA Health Plan Claims data set was analyzed. Patients aged ≥ 12 years with AD who newly initiated advanced therapy after the availability of dupilumab (March 28, 2017) and had ≥ 6 months continuous enrollment before and after their first advanced therapy claim (index date) were included. Advanced therapies included dupilumab, systemic corticosteroids (SCSs), systemic immunosuppressants (SISs), and phototherapy. A multivariate regression model was used to predict annualized follow-up healthcare costs.
In total, 1980 patients were included (61.1% female; mean age, 41.2 years [SD, 17.4]; 11.3% < 18 years). Pre-index date, 65.2% of patients used topical corticosteroids (TCSs; 40.7% and 32.1% used medium and high potency, respectively). The most common advanced therapy was SCSs (N = 1453 [73.4%]; 69.2% prednisone) followed by dupilumab (N = 265 [13.4%]), SISs (N = 99 [5.0%]; 47.5% methotrexate), and phototherapy (N = 163 [8.2%]). Of patients treated with dupilumab, SISs, and phototherapy, 17.4%, 26.3%, and 14.1%, respectively, were prescribed SCSs post-index date. Overall, 62.6% of patients initiating SCSs, 49.1% initiating dupilumab, 64.6% initiating SISs, and 36.2% initiating phototherapy were prescribed TCSs post-index date. Mean annualized total costs (SD) post-index date were $20,722 ($47,014): $11,196 ($41,549) in medical costs ($7973 [$35,133] in outpatient visit costs) and $9526 ($21,612) in pharmacy costs. Mean annualized total cost (SD) varied significantly (P < 0.05) by index treatment: dupilumab, $36,505 ($14,028); SCSs, $17,924 ($49,019); SISs, $24,762 ($47,583); phototherapy, and $17,549 ($57,238).
Switching to combination therapy with SCSs and TCSs was common within 6 months of initiating advanced therapy in patients with AD. Patients also incurred significant pharmacy and outpatient costs. These results highlight the difficulty of managing AD with these existing treatment options.
对于许多人来说，外用治疗方案无法充分控制特应性皮炎（AD）。本分析研究了使用先进疗法的治疗情况及相关费用。
对IQVIA健康计划索赔数据集进行分析。纳入年龄≥12岁、在度普利尤单抗上市（2017年3月28日）后新开始先进疗法且在首次先进疗法索赔（索引日期）前后连续参保≥6个月的AD患者。先进疗法包括度普利尤单抗、全身性皮质类固醇（SCSs）、全身性免疫抑制剂（SISs）和光疗。使用多变量回归模型预测年化随访医疗费用。
共纳入1980例患者（61.1%为女性；平均年龄41.2岁[标准差17.4]；11.3%＜18岁）。在索引日期前，65.2%的患者使用外用皮质类固醇（TCSs；分别有40.7%和32.1%使用中效和高效的）。最常见的先进疗法是SCSs（N = 1453[73.4%]；69.2%为泼尼松），其次是度普利尤单抗（N = 265[13.4%]）、SISs（N = 99[5.0%]；47.5%为甲氨蝶呤）和光疗（N = 163[8.2%]）。在接受度普利尤单抗、SISs和光疗的患者中，分别有17.4%、26.3%和14.1%在索引日期后开具了SCSs。总体而言，在索引日期后，开始使用SCSs的患者中有62.6%、开始使用度普利尤单抗的患者中有49.1%、开始使用SISs的患者中有64.6%以及开始使用光疗的患者中有36.2%开具了TCSs。索引日期后的年化总费用均值（标准差）为20,722美元（47,014美元）：医疗费用为11,196美元（41,549美元）（门诊就诊费用为7973美元[35,133美元]），药房费用为9526美元（21,612美元）。年化总费用均值（标准差）因索引治疗而异（P＜0.05）：度普利尤单抗为36,505美元（14,028美元）；SCSs为17,9,24美元（49,019美元）；SISs为24,762美元（47,583美元）；光疗为17,549美元（,57,238美元）。
在AD患者开始先进疗法的6个月内，转为SCSs和TCSs联合治疗很常见。患者还产生了大量的药房和门诊费用。这些结果凸显了使用这些现有治疗方案管理AD的困难。
