Cost and Drug Utilization Patterns Associated with the Management of Rosacea

November/December 2013, Vol 6, No 9 - Industry Trends
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Rosacea is a chronic skin disease that often requires continuous treatment, but data about healthcare utilization and the costs associated with its management have been lacking, especially for relatively newer therapies. James D. Kendall, PharmD, and Norman J. Preston, PhD, of Galderma Laboratories, LP, recently addressed this information gap in a poster presentation at the 2013 Academy of Managed Care Pharmacy Nexus meeting.1

This retrospective analysis was based on claims data from the IMS LifeLink Health Plan Claims Database between July 1, 2006, and June 30, 2011. This database contains 79 managed care health plans encompassing more than 70 million members who are primarily commercially insured.

Patients with rosacea were identified if they received any prescription drug for the treatment of rosacea. Patients were aged ≥30 years and had at least 1 diagnosis of rosacea. The index date was the time of first prescription for rosacea. A 1-year period after the index date was used to capture pharmacy and medical claims to assess utilization patterns and associated costs.

Dr Kendall and Dr Preston documented the medication possession ratio (MPR), which measures the percentage of time the patient has access to the medication (patients with only 1 prescription had an MPR of zero); therapy changes; and prescribing trends for rosacea and costs associated with the specialty of the prescribing physician (ie, dermatologist or nondermatologist).

Database of Nearly 100,000 Patients A total of 99,894 patients met the inclusion criteria for the analysis. The majority (73.2%) of the patients were women (mean age, 52.4 years). Overall, 81.7% of the patients were treated with a single agent—57.3% received a topical agent and 24.6% received an oral antibiotic. Combination therapy with ≥2 medications was prescribed for 18.3% of patients. The topical medications included metronidazole, azelaic acid, and sulfacetamide sulfur. The oral antibiotics included doxycycline, minocycline, and tetracycline.

Among the patients who received a topical medication, 70% had only 1 prescription filled. “The high one-time fill of topical medication suggests that patients self-dose based on self-diagnosis of rosacea flares,” the researchers commented. Another reason for the high one-time fill of topical medications is that patients may have erythematotelangiectatic rosacea, for which none of the topical therapies has shown a significant effect.

The MPR for monotherapy was higher for oral medications (37.8%) than for topical agents (18.2%). A higher proportion (27%) of patients who were prescribed oral drugs changed therapy than those prescribed a topical agent (17.5%; P <.001).

Costs Associated with Rosacea Treatment The treatment of rosacea incurred primarily pharmacy rather than medical costs. The median annual pharmacy costs, by type of therapy, were:

  • $285 for combination therapy
  • $142 for a topical medication
  • $63 for an oral antibiotic agent.

The median annual rosacea-related medical costs were $0. Of note, prescribing patterns varied according to the medical specialty of the treating physician. Dermatologists were more likely to prescribe oral antibiotics and combination therapies, whereas nondermatologists were more likely to prescribe topical therapies.

Treatment by a dermatologist also was associated with higher costs overall. The median annual pharmacy-related costs per patient were $154 for dermatologists and $137 for nondermatologists; the median rosacea-related medical costs were $37 for dermatologists and $0 for nondermatologists.

When considered by type of drug prescribed, the median annual cost per drug type was significantly different, based on the type of prescriber:

  • Oral antibiotic: $83 when prescribed by a dermatologist versus $46 (P <.001) by a nondermatologist
  • Topical medications: $143 versus $137 (P <.001), respectively
  • Combination therapy: $302 versus $256 (P <.001), respectively.

The various cost and utilization analyses in this study show that “specialist care was associated with more complex treatments, higher costs, and additional physician visits,” Dr Kendall and Dr Preston concluded.

Skin Conditions Top Reason for Medical Visits Dermatologic conditions are often not on a payer’s radar, because the management of skin conditions has not been perceived as a major driver of healthcare utilization and costs. However, the results of a new study may require payers to revise their approach to skin conditions, in light of this new study, which indicates that the general public’s concern about skin conditions is the most common reason to visit a physician in the United States.

Researchers from the Mayo Clinic conducted an extensive review of a large database of 142,377 residents of Olmsted County, MN, in 2009. The study captured adult residents in 2009 and reached a rather unpredictable conclusion—more patients seek medical help for skin disorders than for back pain, colds, arthritis, and other common ailments.2 The researchers were surprised to find that the most prevalent nonacute conditions are not age-related chronic conditions, such as diabetes or heart disease, but are instead conditions that affect men and women equally at all age-groups.

These disorders include, in this order, skin disorders, osteoarthritis and joint disorders, back problems, lipid disorders, and upper respiratory tract disease (excluding asthma).2 “Unexpectedly, almost half of the Olmsted County population of all ages received a diagnosis of skin disorders within approximately 5 years,”2 Sauver and colleagues observed. “Skin disorders are not typically major drivers of disability or death but may be important determinants of healthcare utilization and cost.”2 They also noted that many dermatologic conditions require continued follow-up and treatment.

When grouped according to age, skin disorders were the most prevalent (32.9%) for the youngest age-group (ie, newborn-18 years) in both sexes. This frequency steadily rose across the life span; resulting in 38.2% for the 19- to 29-year age-group, 41.3% for the 30- to 49-year age-group, 50.4% for the group aged 50 to 64 years, and 65.7% for patients aged ≥65 years.2

According to the investigators, the “finding that skin and back problems are major drivers of healthcare utilization affirms the importance of moving beyond the commonly recognized health care priorities....Our findings highlight opportunities to improve healthcare and decrease costs related to common nonacute conditions as we move forward through the changing healthcare landscape.”2

This study sheds new light on the potential role of dermatologic conditions in healthcare utilization and costs and may suggest that payers reexamine their approach to skin conditions, including rosacea, as an increasing and significant driver of healthcare utilization and costs, especially in light of the introduction of new therapies for a variety of skin conditions.

  1. Kendall JD, Preston NJ. Treatment patterns and costs associated with rosacea in the United States. Poster presented at the Academy of Managed Care Pharmacy Nexus meeting; San Antonio, TX; October 15-18, 2013.
  2. St Sauver JL, Jacobson DJ, McGree ME, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88:56-67.
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