Increased utilization of emergency department and inpatient care by patients with hidradenitis suppurativa

Abstract

Background: Hidradenitis suppurativa (HS) is a chronic cutaneous disease with acutely painful flares. In a prior study of all-cause utilization, patients with HS had higher utilization of emergency department (ED) and inpatient care.

Objective: We sought to assess utilization of medical care specifically related to HS, especially high-cost settings.

Methods: The MarketScan medical claims database was examined for participants with either HS or psoriasis based on International Classification of Diseases, Ninth Revision codes, during the study period, January 2008 to December 2012. This was a cohort cost-identification study with analyses of utilization measures and direct costs.

Results: The proportion of the HS cohort hospitalized was 5.1% and was higher than the psoriasis cohort (1.6%) (P < .0001). The proportion of patients who used the ED was also higher in the HS cohort (7.4% vs 2.6%, P < .0001). When compared with a subset of patients with severe psoriasis, the proportions of patients with HS who used the ED (7.4% vs 4.2%, P < .0001) or inpatient care (5.1% vs 2.5%, P < .0001) remained elevated.

Limitations: The study sample may not be generalizable to other patient populations and may represent those with more severe disease. Pharmaceutical costs were not included and confounding factors such as race, socioeconomic status, and insurance type were not investigated.

Conclusion: Patients with HS had increased utilization of high-cost settings, such as the ED and inpatient care, compared with patients with psoriasis, another chronic inflammatory disease. Both patients and providers should be aware of this finding and further work is needed to incorporate assessment of patient outcomes.

Keywords: acne inversa; direct cost; emergency department; health services research; hidradenitis suppurativa; high-cost venue; hospitalization; inpatient; psoriasis.