Comorbidities add treatment burdens to atopic dermatitis
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Key takeaways:
- 58.6% of patients with atopic dermatitis have two or more prescriptions for comorbid conditions.
- Out-of-pocket costs, step therapy and prior authorization represent significant burdens.
Patients with atopic dermatitis with comorbidities face additional treatment burdens and barriers, according to a study published in Annals of Allergy, Asthma & Immunology.
The National Eczema Association (NEA) conducted an online survey in June and July 2021 of adults with AD and of primary caregivers of children with AD, Wendy Smith Begolka, MBS, chief strategy officer, research, medical and community affairs, NEA, and colleagues wrote.
“The National Eczema Association aims to understand all aspects of the lived experience of patients with eczema, which include the impacts of eczema treatment access issues,” Smith Begolka told Healio.
“Atopic dermatitis patients can have associated comorbidities that also require prescription treatments, yet little research has explored a holistic view of the access burdens AD patients face,” she continued.
Study design, results
The analysis reflected results for 913 individuals with AD, including 82.4% who were adults, 67.9% who were female and 70.6% who were white. Also, 6.4% of AD cases were clear, 31.1% were mild, 42.8% were moderate and 19.5% were severe.
There were 609 (66.7%) individuals with at least one comorbidity, including 53.3% with allergic rhinitis, 41.7% with anxiety, 35% with food allergy, 30.7% with depression and 26.9% with asthma. Specifically, 16.2% had no comorbid conditions or were not sure, 17.3% had one, 18.2% had two and 48.3% had three or more.
When asked how many prescription treatments were needed to manage these comorbidities, in addition to their AD, 23.8% said none, 17.5% said one, 18.7% said two, 15.4% said three, 6.8% said four, 4% said five and 13.7% said six or more.
“Atopic dermatitis patients in this study were using, on average, nearly six prescriptions in the past year to manage their AD and associated conditions, and over one in four had challenges obtaining medications for their comorbid conditions,” Smith Begolka said.
The patients who used at least one prescription to treat these comorbidities included 25.7% who said they had a problem getting that treatment in the previous year. Reasons included out-of-pocket costs (50%), step therapy (40.7%), prior authorization (38%) and other (12.7%).
“Other” reasons included problems finding doctors to prescribe or renew medications (n = 11) and delays in mail order prescriptions (n = 6). Meanwhile, 82.5% of patients who only had atopic comorbidities and needed a prescription in the previous year had issues obtaining it.
“The majority of patients who faced an insurance coverage issue for a comorbid condition also faced at least one coverage issue for an AD prescription in the same 12-month period,” Smith Begolka said.
Taken together, she continued, the negative impacts from coverage issues for AD treatments are likely exacerbated by the treatment issues faced for additional, related diagnoses.
“These impacts can include cumulative out-of-pocket costs, but also discontinuity in treatment due to missed doses of prescribed medications,” Smith Begolka said.
The presence of multiple comorbidities with AD warrants a holistic look at the treatment management experiences of these patients, the researchers said. On average, patients used 5.7 ± 2.2 prescriptions for their AD and comorbidities in the previous year.
The 150 respondents who had issues with obtaining prescriptions for their own or their child’s comorbidities in the previous 12 months included 97 (64.7%) who also faced insurance coverage issues for AD prescriptions during the same period.
Further, the researchers said, the treatment needs and issues associated with additional, related diagnoses probably exacerbated the negative impacts of the coverage issues in AD treatments faced by these patients.
Conclusions, next steps
Noting that some treatments may improve atopic comorbidities in addition to AD, whereas others may increase risks for infections and ocular conditions, the researchers called for additional studies.
“Future research should focus on the impact AD treatments may have on comorbidities, which could lower the need for additional prescription treatments and mitigate the substantial treatment cost and access burdens faced by patients,” Smith Begolka said.
Doctors also can help patients who may be having difficulties with coverage, according to Smith Begolka.
“While health care providers cannot always predict prescription coverage issues, they can assist by advising AD patients on what to do if a prescription is delayed or denied, and by improving cross-provider communication to limit polypharmacy, which can exacerbate out-of-pocket costs and the potential for insurance issues,” she said.
Insurers can do more as well, Smith Begolka continued.
“Insurers have a responsibility to offer transparent and timely utilization management approaches, including medically reasonable circumstances for when a health plan should grant an exception request,” she said.
“Additional consideration of the multidimensional burden of AD may also be beneficial in determining these approaches and policies,” she added. “NEA has been engaged on both the state and federal level in advocating for utilization management reforms.”
For more information:
Wendy Smith Begolka, MBS, can be reached at wendy@nationaleczema.org.
Perspective
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This paper addresses an important but underappreciated aspect of AD — its comorbid conditions. As a dermatologist, I often see that AD patients have other medical conditions, including the long-established atopic diseases (food allergy, asthma and allergic rhinitis).
However, this paper highlights other conditions that AD patients suffer from as per self-reporting, including anxiety and depression. Although many AD patients do not have a formal psychiatric diagnosis, they often do show signs of anxiety or depression.
This paper goes beyond describing the comorbid conditions of AD to quantify the financial and treatment access difficulties faced by AD patients as they attempt to manage these comorbid conditions. Literature such as this showing that AD is not a “skin-limited” disease is essential to help influence policymakers to improve medication access.
Future research should examine other AD populations and the difficulties related to access that they face, as this study was limited to patients recruited from a patient advocacy organization who have relatively high levels of education and income. Also, as the efficacy of various AD treatments is studied, their impact on AD comorbidities merits investigation as well.
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