The Social Impact of Rosacea, Patterns of Care, and Associated Costs Featured at AAD 2014

Payer Perspectives in Dermatology - Rosacea
Caroline Helwick

Several studies presented at the 2014 American Academy of Dermatology (AAD) annual meeting sought to characterize the emotional burden of rosacea, as well as what treatments are being prescribed, and how much they are costing the healthcare system.

Stigmatization Is Frequently Felt
More than 33% of patients with rosacea report being “stigmatized” because of their skin condition, and 50% of these individuals avoid social situations, a survey by French investigators showed. The researchers examined the stigma of rosacea and its associated suffering via a survey of a representative sample of adults in the United States, United Kingdom, France, and Germany.

The survey participants completed a clinical questionnaire pertaining to sociodemographic characteristics and disease histories. Patients were considered to feel stigmatized when they reported feeling “dirty/ugly because of their skin condition” and/or that they were the “subject of stares, misconceptions, rude comments or jokes because of their skin condition,” noted Bruno Halioua, PhD, of the Institut Alfred Fournier, Paris, France, and colleagues.

Of the 807 survey responders, 275 reported feelings of stigmatization, representing 34% of the sample. Men reported feelings of stigmatization more frequently than women (49% vs 37%, respectively; P = .029). Men in the sample tended to be younger (mean age, 37 years vs 46 years for women; P = .014).

Marital status, level of education, occupation, and current employment status were not significantly different between patients reporting stigmatization and those who did not.

More than half (54%) of the patients who reported these feelings adopted a coping strategy that consisted of avoiding public contact or canceling social engagements because of their rosacea, according to Dr Halioua and colleagues.

The symptoms of rosacea, including flushing, telangiectasias, papules and pustules, and rhinophyma, were all significantly more frequent in the stigmatization group, although erythema was reported only slightly more, and ocular involvement was not different at all.

The group reporting stigmatization said that they consulted physicians for aesthetic reasons, because of physical symptoms (ie, burning, itching, sensitivity, dryness, irritation), and because of the emotional impact of the disease.

“This is the first study of stigma in rosacea which emphasizes the importance of considering the stigmatization experience and coping in rosacea patients in both future studies and patient treatment,” Dr Halioua and colleagues noted.

They also examined factors associated with the patients’ satisfaction in the treatment of rosacea. The 807 patients in the study were asked to answer 9 questions related to their treatment satisfaction, which was scored from 0 (very dissatisfied) to 10 (very satisfied). Scores of ≤4 indicated “dissatisfied,” and scores of ≥6 were considered “satisfied.”

Of the 427 (51.6%) patients who consulted a physician, 237 (56%) consulted a dermatologist; almost 69% of these patients were satisfied with the consultation. The mean patient satisfaction score related to their consultation with a dermatologist was 7.

Regarding the satisfaction with their management of rosacea, 51% of patients indicated being satisfied by the dermatologist’s helpfulness and willingness to find a solution for their condition, 39% were satisfied with the efficacy of treatment, 31% appreciated the opportunity to discuss rosacea with the dermatologist, and 28% appreciated having a “convincing and reassuring” dermatologist.

Patient satisfaction was linked to the duration of the consultation, which was considered positive if it lasted ≥10 minutes, and was also associated with the type of examination (“close” examination equated with satisfaction), the physician’s advice on symptoms, and the information patients received on available treatments and on side effects.

The achievement of the anticipated outcome more than doubled the likelihood that patients were satisfied with treatment, the study results showed.

“During the interaction between patients and physicians, the key determinant factors of patient satisfaction were counseling, duration of consultation and the type of examination,” Dr Halioua and colleagues concluded.

Delay in Seeking Treatment
Despite having symptoms, most patients with rosacea wait up to 5 years before seeking treatment, according to a literature search on PubMed and the National Rosacea Society website for information that quantitatively or qualitatively describes the patient experience. Although this literature is limited, a few findings were gleaned by Sandy Kuo, MS, and colleagues, of Wake Forest School of Medicine, Winston-Salem, NC.

The literature search also revealed that long-term treatment of rosacea is often required for maintenance, and that 28% of patients took “time off” from their treatment regimen.

“Actual non-adherence is likely higher,” according to the investigators, who suggested that “better understanding of the patient perspective can lead to better patient adherence to treatment, and thus improved quality of life and satisfaction.”

Treatment Patterns of Rosacea and Associated Costs
Recent studies of treatment patterns and costs in rosacea were based on data from 2002 to 2005, but many new treatments have entered the marketplace since then. James D. Kendall, PharmD, and Norman J. Preston, PhD, of Galderma Laboratories, L.P., Fort Worth, TX, analyzed current treatment patterns and costs in a retrospective study using the IMS LifeLink Health Plan Claims Database, which encompasses more than 79 managed care health plans covering more than 70 million lives.

A total of 99,894 patients were included in this analysis, most (73%) of whom were women, and their mean age was 52 years. Most (82%) patients were receiving monotherapy, and most (70%) received a topical medication.

Of the patients prescribed a topical medication, 70% had only 1 fill. The medical possession ratios were 37.8% for oral medications and 18.2% for topical medications, Dr Kendall and Dr Preston reported.

Rosacea-related medical and pharmacy costs were highest for combination therapy (medical, $70; pharmacy, $536). Oral and combination therapies were more likely to be prescribed by a dermatologist, whereas topical medications were mostly prescribed by nondermatologists.

By specialty, rosacea-related medical costs were $73 for dermatologists and $33 for nondermatologists; pharmacy costs were $343 and $221, respectively.

Not surprising, “specialist care was associated with more complex treatments, higher costs, and additional physician visits,” Dr Kendall and Dr Preston noted.

“The high one time fill of topical medication suggests that patients self-dose based on self-diagnosis of rosacea flares rather than in response to a specialist visit,” they concluded.

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Last modified: June 27, 2014
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