McConnell R C, Fleischer A B, Williford P M, Feldman S R
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Am Acad Dermatol. 1998 Feb;38(2 Pt 1):221-6. doi: 10.1016/s0190-9622(98)70598-5.
Topical tretinoin is effective treatment for both acne and photoaging. This creates a problem for insurers that cover medication costs, because treatment of acne is often covered but treatment of photoaging is not. The age distributions of patients with acne or photoaging are likely to be very different. Therefore, one approach insurers can use is an age cutoff for covering the cost of topical tretinoin therapy.
Our purpose was to determine at what age patients are more likely to receive tretinoin for treatment of acne vulgaris versus other conditions to provide a rational basis for insurers to set coverage cutoffs.
National Ambulatory Medical Care Survey data for the years 1990 to 1994 were analyzed to ascertain the age distribution of acne vulgaris office visits and treatment with topical acne agents including tretinoin. These data were compared to office visits and tretinoin treatment of wrinkles, solar elastosis, and other conditions.
The mean age (+/- standard deviation) of patients seen for acne vulgaris was 24.3 +/-11.5 years old. The age distribution of topical tretinoin treatment paralleled the age distribution of acne. Tretinoin treatment of acne and of nonacne conditions were equal at an age of 44.
The distribution of outpatient visits for acne treatment is skewed toward older patients and persists beyond age 40. A rational age cut-off for coverage of topical tretinoin treatment is 40 years.
外用维甲酸对痤疮和光老化均为有效的治疗方法。这给承担药物费用的保险公司带来了一个问题，因为痤疮治疗费用通常在承保范围内，而光老化治疗费用则不在承保范围内。痤疮或光老化患者的年龄分布可能有很大差异。因此，保险公司可以采用的一种方法是设定外用维甲酸治疗费用承保的年龄界限。
我们的目的是确定患者在什么年龄更有可能接受维甲酸治疗寻常痤疮而非其他病症，从而为保险公司设定承保界限提供合理依据。
分析1990年至1994年的国家门诊医疗护理调查数据，以确定寻常痤疮门诊就诊以及使用包括维甲酸在内的外用痤疮药物治疗的年龄分布。将这些数据与皱纹、日光性弹力组织变性及其他病症的门诊就诊和维甲酸治疗情况进行比较。
因寻常痤疮就诊患者的平均年龄（±标准差）为24.3±11.5岁。外用维甲酸治疗的年龄分布与痤疮的年龄分布相似。在44岁时，维甲酸治疗痤疮和非痤疮病症的情况相同。
痤疮治疗的门诊就诊分布偏向年龄较大的患者，且在40岁以后仍持续存在。外用维甲酸治疗承保的合理年龄界限为40岁。
