J Drugs Dermatol. 2023 Feb 1;22(2):154-164. doi: 10.36849/JDD.7038.
Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with OOP expenses in AD is poorly understood.
To characterize prescription polypharmacy and its association with OOP healthcare expenses among individuals with AD.
An online survey was administered to National Eczema Association members (N=113,502). Inclusion criteria (US resident, age ≥18, self-reported or caregiver of individual with AD) was met by 77.3% (1,118/1,447) of respondents.
Polypharmacy (≥5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits, and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P≤0.01). Polypharmacy noted with all prescription therapies was most associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor (P≤0.0005) use. Respondents with polypharmacy had increased OOP expenditures across numerous categories, including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P<0.005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs than average, and more harmful household financial impact (P<0.0001 for all).
Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and harmful financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes. J Drugs Dermatol. 2023;22(2): doi:10.36849/JDD.7038.
特应性皮炎（AD）的自付费用很高，会影响家庭财务状况。处方药物的联合使用及其与 AD 自付费用的关系尚不清楚。
描述 AD 患者处方药物的联合使用情况及其与自付医疗费用的关系。
对全国湿疹协会（NEDA）成员进行了在线调查（N=113502）。1447 名符合条件的参与者中，77.3%（1118/1447）为应答者。
联合使用 5 种以上治疗 AD 的药物与 AD 严重程度增加、控制不佳、发作增加、就诊次数增加以及共患哮喘、过敏性鼻炎、食物过敏和皮肤感染有关（P≤0.01）。与所有处方治疗药物相关的联合使用最常与生物制剂（度普利尤单抗）、口服免疫抑制剂（硫唑嘌呤、环孢素、甲氨蝶呤、皮质类固醇）、口服抗菌药物和局部钙调磷酸酶抑制剂有关（P≤0.0005）。使用联合药物的患者在多个类别中的自付支出增加，包括就诊共付额、保险覆盖和不覆盖的处方药、住院、急诊就诊、心理健康服务、非处方药，如助眠剂、镇痛药和补充剂以及替代药物（P<0.005）。使用联合药物的患者每年的自付费用较高（中位数[范围]：1200 美元[0-200000 美元]），每月自付费用高于平均水平，对家庭经济造成的危害更大（P<0.0001）。
AD 患者报告了大量的联合用药，这与自付费用增加和严重的经济影响有关。需要采取策略来减少联合用药，降低自付费用，优化临床结果。
