Abstract
Introduction: Atopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system. Methods: In this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017. Results: 9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026. Conclusions: Despite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI.
| Original language | English |
|---|---|
| Journal | Dermatology and therapy |
| Volume | 12 |
| Issue number | 8 |
| Pages (from-to) | 1925-1945 |
| Number of pages | 21 |
| ISSN | 2193-8210 |
| DOIs | |
| Publication status | Published - 08.2022 |
Funding
This study and the journal’s Rapid Service Fee were sponsored by Pfizer in Germany. The authors would like to thank Ariane Höer and Anja Mocek, employees of IGES Institut GmbH, which was contracted and reimbursed by Pfizer in Germany to design the study, conduct the analyses, interpret the results, and to write the manuscript, for providing pharmacological expertise and publication support, respectively. In addition, the authors would like to thank Marie Sebald, a former employee of Pfizer in Germany, for her outcomes research expertise and publication support. All three did not receive project-specific funding for their assistance. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Marie Schild, Agnes Kisser, Christoph Ohlmeier, and Holger Gothe were involved in the design of the study. Valeria Weber, Wolfgang Galetzka, Dirk Enders, Christoph Ohlmeier, and Holger Gothe were involved in the analysis. Marie Schild, Valeria Weber, Diamant Thaçi, Agnes Kisser, Franziska Zügel, Christoph Ohlmeier, and Holger Gothe were involved in the data interpretation. Marie Schild and Valeria Weber contributed equally to this work and, thus, share the first authorship. They wrote the manuscript with contributions from Diamant Thaçi, Agnes Kisser, Wolfgang Galetzka, Dirk Enders, Franziska Zügel, Christoph Ohlmeier, and Holger Gothe. All authors read and approved the final manuscript. All authors had complete autonomy for the process of designing the study, carrying out the analyses, interpreting the results and writing the manuscript. This also includes the full right to publish the results without limitation. Agnes Kisser and Franziska Zügel are paid employees of Pfizer in Germany. Marie Schild was an employee of Pfizer in Germany at the time of her contribution but is no longer affiliated with Pfizer in Germany. Valeria Weber and Holger Gothe are paid employees of the vendor IGES Institut GmbH, which is a paid consultant of Pfizer in Germany for designing the study, carrying out the analyses, interpreting the results and writing the manuscript. Christoph Ohlmeier was a paid employee of the vendor IGES Institut GmbH at the time of his contribution but is no longer affiliated with IGES Institut GmbH. Diamant Thaçi worked as investigator, consultant, and member of scientific board or speaker for AbbVie, Amgen, Almirall, Bristol-Myers Squibb, Biogen-Idec, Boehringer Ingelheim, Dermira, DS Biopharma, Eli Lilly, Galapagos, Galderma, Janssen-Cilag, LEO Pharma, Novartis, Pfizer, Regeneron, Roche-Possay, Samsung, Sandoz, Sanofi, Sun-Pharma and UCB. Dirk Enders is an employee of the vendor InGef, which was contracted and reimbursed by the IGES Institut GmbH. Wolfgang Galetzka was an employee of the vendor InGef at the time of his contribution but is no longer affiliated with InGef. Since all patient-level data in the database are anonymized to comply with German data protections regulations and German federal law, approval of an Ethics Committee was not required. The research was conducted in accordance with the Declaration of Helsinki. The data used in this study cannot be made available in the manuscript, the supplemental files, or in a public repository due to German data protection laws (Bundesdatenschutzgesetz). To facilitate the replication of results, anonymized data used for this study are stored on a secure drive at the InGef GmbH. Access to the data used in this study can only be provided to external parties under the conditions of the cooperation contract of this research project and can be assessed upon request, after written approval ([email protected]), if required.
Research Areas and Centers
- Academic Focus: Center for Infection and Inflammation Research (ZIEL)
- Centers: Center for Research on Inflammation of the Skin (CRIS)
DFG Research Classification Scheme
- 2.22-19 Dermatology
