WASHINGTON – One in four hidradenitis suppurativa patients saw their disease become more severe, requiring significantly more health care resources and driving up health care spending.
Dr. Alexa Boer Kimball, professor of dermatology at Harvard Medical School, Boston, and her colleagues reviewed commercial claims in the OptumHealth Reporting and Insights Database from 1998 through early 2014, identifying 1,314 adult patients treated for hidradenitis suppurativa (HS). About a quarter of these patients (323) experienced an increase in the severity of their disease, represented by an inpatient or emergency department visit or skin surgery performed on the same day as a dermatologic diagnosis. Their findings were presented at the annual meeting of the American Academy of Dermatology.
Dr. Alexa Boer Kimball
“Patients with hidradenitis suppurativa use a substantial level of health care resources, especially given their relatively young age,” Dr. Kimball said in an interview. “The results of this study suggest that if we can implement effective therapies that prevent patients from progressive disease, we may not only be able to improve their outcomes but also meaningfully reduce costs to the health care system.”
Patients who progressed to a more severe form of HS had significantly more outpatient visits (incidence rate ratio, 1.35), as well as inpatient visits (IRR, 2.48), emergency department visits (IRR, 1.71), and other medical service visits (IRR, 1.81), compared with those whose disease did not progress (all, P less than .001).
The most common indicators of disease progression included skin surgery (62%) and the initiation of a strong pain reliever (34%), Dr. Kimball noted.
Health care costs for patients whose disease progressed was $5,052 higher than were costs for those whose disease did not progress. Cost increases were driven mainly by higher outpatient costs and high inpatient costs (for both, P less than .05). Differences in pharmacy costs were not statistically significant.
“To date, no guidelines are available in the United States for the management of hidradenitis suppurativa and, until very recently, there was no treatment approved in the U.S.,” Dr. Kimball and her colleagues said.
Adalimumab gained Food and Drug Administration approval for moderate to severe HS in 2015.
On Twitter @denisefulton