Overuse of Systemic Corticosteroids, Substantial Cost Burden for AD Seen in Germany

Systemic corticosteroids (SCS) were more commonly prescribed vs other systemic drug options in Germany for patients with atopic dermatitis (AD), with substantial direct and indirect costs cited among these populations. Findings were published recently in Dermatology and Therapy.

For patients with more severe uncontrolled AD, treatment recommendations include phototherapy (recommended for adults only), systemic immunosuppressive agents (SIS), biologics, and SCS, the latter of which is associated with an unfavorable risk-benefit profile.

Current German and European guideline recommendations refer to a restricted usage of SCS to adult patients, whereas usage in nonadult patients should be handled with caution. Recently approved biologic options, such as dupilumab, have been associated with significant improvement in AD signs, symptoms, and quality of life compared with placebo, in adolescent and adult patients.

“There are few studies investigating the recent medical care situation and resource utilization of patients with AD undergoing systemic drug therapy in the German health care context,” said the study authors.

They conducted a retrospective cohort study of aggregated anonymized German health claims data from the InGef research database to assess current treatment patterns, health care resource utilization (HCRU), and associated costs in patients with AD and a systemic drug therapy initiation (SDTI) between January 1 and December 31, 2017 (index period).

Systemic drug therapy included dupilumab, SCS, and SIS, with patients observed for 1 year. Data on demographics and diagnosed comorbidities were also collected among the study cohort.

“All-cause direct costs comprised the following categories: outpatient costs, hospitalization costs, and overall prescription medication costs. Direct costs due to AD included outpatient phototherapy costs, costs for hospitalizations due to AD, and AD-related prescription medication costs,” explained the researchers.

A total of 9975 patients were included in the analysis (mean [SD] age, 39.6 years [25.5]; 57.8%, female), in which 26.7% of the patients were younger than 18 years, with 22.5% aged 2 to 11 years and 4.2%, 12 to 17 years. The mean number of comorbidities, as measured via the Elixhauser Comorbidity Score, was 2.3 (2.5).

In the 1-year observation period, the most common systemic drug therapy prescribed was SCS (99.2%), whereas administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine, 0.5%; azathioprine, 0.6%; methotrexate, 0.1%). An additional 2.8% of patients received phototherapy and 41.6% used topical corticosteroids and/or topical calcineurin inhibitors.

The median treatment durations of SCS, cyclosporine, and azathioprine were 27, 102, and 109 days, respectively.

Regarding HCRU and associated costs, the average annual expenditure for medications amounted to €1237 ($1264.25) per patient . Outpatient services were used by 99.6% of patients, with associated mean annual costs of €943 ($963.77). At least 1 hospitalization was cited in 25.4% of patients (mean annual costs, €5836 [$5964.57]), and 5.3% of adult patients received sickness benefits, with associated mean annual costs of €5026 ($5136.72).

“The results suggest that the duration of treatment with SCS and their frequent use in nonadult patients exceed the recommendations of current guidelines in the majority of cases. They further suggest a substantial direct and indirect cost burden of patients with AD and SDTI,” concluded researchers.

They added that their study findings should be interpreted cautiously due to several limitations and that further research based on current real-world data is needed to investigate the changing treatment situation with the availability of dupilumab and other new systemic drug therapies in Germany.

Reference

Schild M, Weber V, Thaci D, et al. Treatment patterns and healthcare resource utilization among patients with atopic dermatitis: A retrospective cohort study using German health claims data. Dermatol Ther (Heidelb). Published online July 24, 2022. doi:10.1007/s13555-022-00773-3