Atopic Dermatitis Polypharmacy and Out-Of-Pocket Healthcare Expenses

February 2023 | Volume 22 | Issue 2 | 154 | Copyright © February 2023


Published online January 27, 2023

doi:10.36849/JDD.7038Citation: Chovatiya R, Begolka WS, Thibau IJ, et al. atopic dermatitis polypharmacy and out-of-pocket healthcare expenses. J Drugs Dermatol. 2023;22(2):154-164. doi:10.36849/JDD.7038

Raj Chovatiya MD PHDa, Wendy Smith Begolka MBSb, Isabelle J. Thibau MPHb, Jonathan I. Silverberg MD PhD MPHc

aDepartment of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
bNational Eczema Association, Novato, CA
cDepartment of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC

Abstract
Background: 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.
Objective: To characterize prescription polypharmacy and its association with OOP healthcare expenses among individuals with AD.
Methods: 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.
Results: 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).
Conclusion: 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

Citation: Chovatiya R, Begolka WS, Thibau IJ, et al. atopic dermatitis polypharmacy and out-of-pocket healthcare expenses. J Drugs Dermatol. 2023;22(2):154-164. doi:10.36849/JDD.7038

INTRODUCTION

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with variable lesional morphology, distribution, symptoms, comorbidities, and quality of life (QOL) burden.1-8 These clinical domains contribute to heterogenous severity and longitudinal course, which in turn contribute to heterogenous treatment patterns consisting of polypharmacy, complex therapeutic regimen, and even non-evidence-based or alternative treatments.9 Polypharmacy, which refers to the regular use of numerous treatments (usually ≥5, but described as anywhere between 2-11),10 is associated with medication-related adverse events (AEs), inappropriate medication use, medication non-adherence, and, especially among the elderly, increased frailty, falls, and mortality.11-16 Polypharmacy is also associated with an increased healthcare system burden, including impaired healthcare workflow, decreased healthcare provider (HCP) productivity, increased medication errors, increased healthcare visits, and increased costs.17-19

Atopic dermatitis is associated with increased healthcare resource use, including emergency, acute/urgent, outpatient, and inpatient care,20-23 direct healthcare costs, and indirect societal costs (ie, work productivity and activity impairment).24-26 For individuals with AD and their caregivers, out-of-pocket (OOP) expenses are especially meaningful for the daily management of household finances. US population-based studies have shown increased overall OOP expenses among individuals with AD.26,27 Using a nationally-representative survey, we recently demonstrated that increased OOP AD costs in a variety of healthcare and non-healthcare categories are associated with harmful household financial impact, increased outpatient healthcare use, and comorbid burden, especially
Close Menu