Targeting the Clinical, Economic and Payer Considerations of Atopic Dermatitis - Episode 4
Indirect costs associated with atopic dermatitis, and the financial burden associated with delayed treatment initiation or inappropriate therapy.
Bhavesh Shah, RPh, BCOP: If we look at the literature out there, most of what has been published is around the pediatric patient population. Recently we’ve seen more literature around the adult patient population, so it’s great to have visibility into that. One thing we have to understand is that the economic burden for atopic dermatitis goes beyond the skin disease itself. It’s not a fatal disease. You’re not having patients who are getting admitted to the hospital and requiring long stays, but there’s a significant quality-of-life impact and indirect costs from the burden of the disease, which we are sometimes unable to quantify.
There was a very large economic analysis done from about 2017 to 2019. It identified that there was an increase in total all-causes health care–related costs, which was about $2,600 higher. There was also this all-causes prescription increase in this patient population that didn’t have adequate control of their atopic dermatitis, and that was about $5,000 higher than your patients who didn’t have atopic dermatitis or had controlled atopic dermatitis. Then we forget about the indirect costs that these patients would have, which is not measured by the payer because there are disability claims that are impacting that indirect cost.
This economic analysis also looked at the disability claims, which were also much higher for patients with uncontrolled atopic dermatitis. There was this greater utilization of outpatient services, outpatient prescriptions, and disability claims. It ties to the quality of life of the patient. You have a patient who’s constantly having pruritis, which is preventing them from sleeping, and they’re not able to function properly or have adequate productivity. There are sleep disturbances and then there are comorbidities that these patients have. There’s downstream anxiety and depression. Something that we saw with the pediatric patient population was that their mental health was impacted.
Peter A. Lio, MD: Many of our patients are unhappy with their treatment. They feel like they’re not getting the answers they want or the treatment that they want, and there’s no doubt that undertreating this disease has a huge cost to the patients and their families. Part of the theory is that we may be able to modify the disease long term. This is still in the theoretical phase, but if we take into account that there’s a chance of treating atopic dermatitis early and effectively, we could alter the outcome or maybe reduce the risk of some of the comorbidities we’ve discussed, rather than intensify them even more. But even that’s not proven.
We know that the longer people are suffering, the longer they’re not getting good care, and the longer they’re not getting good sleep, the more they’re having pain and itch. All these things can work together to add to this terrible deficit of burden that they have already. It’s important that we treat people as quickly as we can and get them to that clear or almost-clear status as soon as we can safely—and keep them clear, because that’s the only way to get them out of this loop.
Bhavesh Shah, RPh, BCOP: The economic and clinical burden of ineffective therapy is tied to the main things I mentioned in terms of quality life for the patient. You have patients with a significant number of sleep disturbances, anxiety, and depression. All these factors will lead to this indirect cost. The clinical implications are that this may turn into a patient going to their provider more. Essentially, there’s also a cost to the payer. Every time that patient goes to see a provider because of ineffective therapy, or when therapy isn’t optimized, there’s a visit that requires a prescription. It could be that it’s a change of therapy. It’s a change of therapy to more effective therapy, but a significant amount of time that has passed before this patient is able to see a provider. Because we know that access is a big component for patients who they can’t just see a provider tomorrow. It could be 6 months. You could imagine what would lead to that patient going to the ED [emergency department] and receiving treatment from a nonspecialized dermatology provider prescribing drugs that may not be effective. There’s definitely a circle of delay and ineffective therapies that drives the increase in health care resource utilization.
Transcript edited for clarity.