Medication Choice and Associated Health Care Outcomes and Costs for Patients With Acne and Acne-Related Conditions in the United States
July 2011 | Volume 10 | Issue 7 | Original Article | 766 | Copyright © July 2011
Palak Patel MS,a Hsien-Chang Lin PhD,b,c Steven R. Feldman MD PhD,d Alan B Fleischer Jr MD,d Milap C. Nahata MS PharmD,e Rajesh Balkrishnan PhDb,c
aClinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA bClinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI cCenter for Medication Use, Policy and Economics, University of Michigan, Ann Arbor, MI dCenter for Dermatology Research, Wake Forest University, Winston-Salem, NC ePharmacy Practice and Administration, College of Pharmacy, The Ohio State University, Columbus, OH
Abstract
Background: Acne is a common condition for which multiple treatment options are available. The patterns of pharmacotherapy for
acne and similar conditions, and the effect of those patterns on cost, are not well characterized.
Objective: This study examined the impacts of patient demographics and medication choices on patients' health status and associated
medication costs.
Methods: A retrospective cross-sectional study was conducted using the 2007 Medical Expenditure Panel Survey (MEPS) database.
Information on patient demographics, health status, medication utilization and medication costs was obtained from the database
representing 3,784,816 patients with acne and similar conditions.
Results: Weighted multiple linear regression analyses indicated that the use of topical retinoids was preferred in combination with
other treatments rather than as monotherapy. Oral antibiotics were widely prescribed and their use was associated with a significant
decrease in total annual prescription spending. Use of oral retinoids and oral contraceptives increased the annual prescription costs
significantly. Increase in annual drug refills was not associated with the improvement in health status.
Conclusion: We observed an association with medication choice for acne and acne-related conditions on medication spending. Pharmacologic
treatment of acne significantly adds to acne-related annual healthcare costs compared to non-pharmacologic treatment.
J Drugs Dermatol.2011;10(7):766-771.
INTRODUCTION
Acne is one of the most common skin diseases in the
United States, affecting more than 85 percent of adolescents
and frequently continuing into adulthood.1 Approximately
95 percent of the population is affected by acne at
some time during their lives.2 There is a tremendous number
of visits made to both generalists and dermatologists for the
treatment of acne, as it is one of the most common disorders.3
The direct cost of acne treatment in the United States is estimated
to be more than $1 billion per year and approximately
$100 million is spent on over-the-counter acne medications.4
Medications are thought to be significant predictors to the billions
of dollars spent on the treatment of acne.3 Because of the
limited healthcare resources available, the importance of pharmacoeconomics
for the treatment of diseases such as acne has
increased over the years.
Standard treatment for acne is topical therapy.5 Topical retinoids
play a pivotal role in both the early and maintenance phases
of acne management.5 Topical antibiotics such as clindamycin
can be used effectively for the treatment of acne.5 However,
long term use of these antibiotics is associated with the development
of bacterial resistance to these drugs.5 Therefore, the
combination of antibiotics with other treatments such as topical
retinoids and/or benzoyl peroxide is preferred. Combination
therapy is widely used in the management of acne, with the
exception of pure comedonal acne.6 Combination of adapalene
0.1% with bezoyl peroxide 2.5% is found to be more effective
than monotherapy with either agent, and one study also reported
that this fixed dose combination gel is as well tolerated
as adapalene gel and benzoyle peroxide gel alone in terms of
cumulative irritation.7,8 Fixed dose combination products also
improve patient convenience, resulting in improved patient
adherence.9 Use of topical retinoids is recommended in combination
with an antimicrobial agent as first line therapy for most
patients with acne to target multiple pathogenic features and
both inflammatory and noninflammatory acne lesions.9
