Comorbidities, costs among patients with hidradenitis suppurativa continue to rise

Key takeaways:

• The comorbidity burden was high and continued to accumulate even after the approval of biologic therapy.
• Most patients are treated by nonspecialized health care providers.

Comorbidities, health care utilization and costs are increasing for patients with hidradenitis suppurativa, prompting a need for better disease management, according to a study.

“Hidradenitis suppurativa (HS) is a chronic, autoinflammatory, recurrent, debilitating skin disease characterized by painful, deep lesions predominantly located in the axillary, inguinal and anogenital regions,” Amit Garg, MD, professor and founding chair of the department of dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and colleagues wrote. “Current registry data have suggested an increasing incidence in the United States.”

Not only are the incidence rates of HS increasing, but with adalimumab the only biologic approved to treat HS, patients are left with limited treatment options. To better manage this disease, Garg and colleagues evaluated the sociodemographic, clinical and socioeconomic characteristics of patients with HS over a 3-year period.

The retrospective study included 10,230 adults (mean age, 47.1 years; 69.8% women), 628 adolescents (mean age, 15.3 years; 84.9% girls) and 51 patients aged younger than 12 years with HS.

Results showed that all adolescent patients were covered with commercial insurance, whereas 68.7% of adults had commercial insurance and 31.3% had Medicare.

A higher number of HS diagnoses were reportedly given by general practitioners and pediatricians (adults, 41.6%; adolescents, 39.6%) compared with dermatologists (adults, 22.1%; adolescents, 30.6%).

Comorbidities

At pre-index, the most common Charlson comorbidity among adults at 20.4% was diabetes without complications. This was followed by chronic pulmonary disease at 16.4% and diabetes with complications at 9%.

Among adolescents, comorbidities were low except for chronic pulmonary disease at 10.7% in the 2-year post index. Notably, the researchers said this comorbidity was “likely asthma rather than chronic obstructive pulmonary disease.”

Elixhauser comorbidities such as uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19%) and depression (17.4%) were common among adult patients and increased over time.

Depression (11%), obesity (10%) and chronic pulmonary disease (8.3%) were high at all time periods for adolescents with depression and obesity increasing over time.

Overall, the authors found that the comorbidity burden was high and continued to accumulate even after the approval of biologic therapy.

Treatment patterns

While surgical procedures were relatively uncommon, incision and drainage were the most frequently used procedures among adults (7.6%) and adolescents (6.4%).

Adolescents received more topical and systemic antibiotics than adults (25% vs. 41.7%, 65.1% vs. 74.5%, respectively); however, adults used more analgesics, including opioids to treat HS-related pain, compared with adolescents (10.6% vs. 6.2%).

Biologic treatment was an uncommon treatment option, with 3.5% of adults and 1.8% of adolescents utilizing biologics.

Health care resource utilization, associated costs

All patients reported high utilization of health care resources, with the average number of visits per adult being 10.5 and per adolescent being 6.9 at 1-year pre-index.

This study confirmed that most in-office and outpatient visits were not within dermatologic or surgical specialties, as Healio previously reported.

“This suggests a possible undermanagement of the disease, with patients being treated by non-specialist [health care providers],” Garg and colleagues wrote. “Given the complexity of HS as a disease, treatment of HS by a non-dermatologist may result in a lack of effective medical treatment, misdiagnosis, or a delay in diagnosis.”

At the 2-years post-index time period, total health care costs amounted to $42,143 for adults and $16,057 for adolescents, with outpatient costs being the most.