Cost and Drug Utilization Patterns Associated with the Management of Rosacea

Payer Perspectives in Dermatology
Caroline Helwick

Rosacea is a chronic skin disease that often requires continuous treatment, but data about healthcare utilization and the costs associated with its management have been lacking, especially for relatively newer therapies. James D. Kendall, PharmD, and Norman J. Preston, PhD, of Galderma Laboratories, LP, recently addressed this information gap in a poster presentation at the 2013 Academy of Managed Care Pharmacy Nexus meeting.

This retrospective analysis was based on claims data from the IMS LifeLink Health Plan Claims Database between July 1, 2006, and June 30, 2011. This database contains 79 managed care health plans encompassing more than 70 million members who are primarily commercially insured.

Patients with rosacea were identified if they received any prescription drug for the treatment of rosacea. Patients were aged ≥30 years and had at least 1 diagnosis of rosacea. The index date was the time of first prescription for rosacea. A 1-year period after the index date was used to capture pharmacy and medical claims to assess utilization patterns and associated costs.

Dr Kendall and Dr Preston documented the medication possession ratio (MPR), which measures the percentage of the time the patient has access to the medication (patients with only 1 prescription had an MPR of zero); therapy changes; and prescribing trends for rosacea and costs associated with the specialty of the prescribing physician (ie, dermatologist or nondermatologist).

Database of Nearly 100,000 Patients
A total of 99,894 patients met the inclusion criteria for the analysis. The majority (73.2%) of the patients were women (mean age, 52.4 years). Overall, 81.7% of the patients were treated with a single agent—57.3% received a topical agent and 24.6% received an oral antibiotic. Combination therapy with ≥2 medications was prescribed for 18.3% of patients. The topical medications included metronidazole, azelaic acid, and sulfacetamide sulfur. The oral antibiotics included doxycycline, minocycline, and tetracycline.

Among the patients who received a topical medication, 70% had only 1 prescription filled. “The high one-time fill of topical medication suggests that patients self-dose based on self-diagnosis of rosacea flares,” the researchers commented. Another reason for the high one-time fill of topical medications is that patients may have erythematotelangiectatic rosacea, for which none of the topical therapies has shown a significant effect.

The MPR for monotherapy was higher for oral medications (37.8%) than for topical agents (18.2%). A higher proportion (27%) of patients who were prescribed oral drugs changed therapy than those prescribed a topical agent (17.5%; P <.001).

Costs Associated with Rosacea Treatment
The treatment of rosacea incurred primarily pharmacy rather than medical costs. The median annual pharmacy costs, by type of therapy, were:

  • $285 for combination therapy
  • $142 for a topical medication
  • $63 for an oral antibiotic agent.
The median annual rosacea-related medical costs were $0. Of note, prescribing patterns varied according to the medical specialty of the treating physician. Dermatologists were more likely to prescribe oral antibiotics and combination therapies, whereas nondermatologists were more likely to prescribe topical therapies. Treatment by a dermatologist also was associated with higher costs overall. The median annual pharmacy-related costs per patient were $154 for dermatologists and $137 for nondermatologists; the median rosacea-related medical costs were $37 for dermatologists and $0 for nondermatologists. When considered by type of drug prescribed, the median annual cost per drug type was significantly different, based on the type of prescriber:
  • Oral antibiotic: $83 when prescribed by a dermatologist versus $46 (P <.001) by a nondermatologist
  • Topical medications: $143 versus $137 (P <.001), respectively.
  • Combination therapy: $302 versus $256 (P <.001), respectively.
The various cost and utilization analyses in this study show that “specialist care was associated with more complex treatments, higher costs, and additional physician visits,” Dr Kendall and Dr Preston concluded.
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Last modified: December 6, 2013
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