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


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.


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