Burden of Atopic Dermatitis in the United States: Analysis of Healthcare Claims Data in the Commercial, Medicare, and Medi-Cal Databases

Abstract

Introduction: Comparative data on the burden of atopic dermatitis (AD) in adults relative to the general population are limited. We performed a large-scale evaluation of the burden of disease among US adults with AD relative to matched non-AD controls, encompassing comorbidities, healthcare resource utilization (HCRU), and costs, using healthcare claims data. The impact of AD disease severity on these outcomes was also evaluated.

Methods: Adult AD patients in the Commercial (n = 83,106), Medicare (n = 31,060), and Medi-Cal (n = 5550) databases were matched (1:1) to non-AD controls by demographic characteristics. AD patients were stratified by disease severity (higher, lower) using treatment as a surrogate measure of severity. The comorbidity burden, HCRU, and costs were evaluated during a 12-month follow-up period.

Results: In the Commercial, Medicare, and Medi-Cal populations, patients with AD had a significantly higher overall comorbidity burden (P < 0.0001), an increased risk of asthma and allergic rhinitis (both P < 0.0001), higher HCRU (P < 0.05), and higher mean total per patient costs (Commercial: US$10,461 versus US$7187; Medicare: US$16,914 versus US$13,714; Medi-Cal; US$19,462 versus US$10,408; all P < 0.0001), compared with matched non-AD controls. Higher disease severity was associated with an increased comorbidity burden (P < 0.0001), HCRU (P < 0.05), and total costs (Commercial: US$14,580 versus US$7192; Medicare: US$21,779 versus US$12,490; Medi-Cal; US$22,123 versus US$16,639; all P < 0.0001) relative to lower severity disease.

Conclusion: In this large-scale, healthcare claims database analysis, AD patients had a significantly higher comorbidity burden, HCRU, and costs compared with matched non-AD controls. Higher disease severity was associated with an even greater comorbidity and economic burden.

Funding: Sanofi and Regeneron Pharmaceuticals, Inc.

Keywords: Atopic dermatitis; Burden of disease; Comorbidities; Dermatology; Disease severity; Healthcare resource utilization; Insurance claims database.

Fig. 1

Sample selection in the Commercial, Medicare, and Medi-Cal populations. For atopic dermatitis (AD) patients, the index date was defined as the date of the first diagnostic claim of AD; for non-AD controls, it was randomly assigned within the index event identification period

Fig. 2

Flowcharts of: a atopic dermatitis (AD) patients and matched non-AD controls; b AD patients stratified by disease severity

Fig. 3

Adjusted odds ratios of prespecified comorbidities in atopic dermatitis (AD) patients and matched non-AD controls in: a Commercial, b Medicare, and c Medi-Cal populations. Variables included in the generalized linear model: age, gender, race, and non-AD-related comorbidities. ADHD attention deficit hyperactivity disorder, CI confidence interval

Fig. 4

Adjusted odds ratios of prespecified comorbidities stratified by disease severity in: a Commercial, b Medicare, and c Medi-Cal populations. Variables included in the generalized linear model: age, gender, race, and non-AD-related comorbidities. AD atopic dermatitis, ADHD attention deficit hyperactivity disorder, CI confidence interval

Fig. 5

Adjusted mean annual number of healthcare visits and number of prescriptions per patient in AD patients and matched non-AD controls in: a Commercial, b Medicare, and c Medi-Cal populations. *P < 0.05. Variables included in the generalized linear model: age, gender, race, non-AD-related comorbidities, and region (Commercial and Medicare only). AD atopic dermatitis, ER emergency room, N/A not applicable

Fig. 6

Mean annual number of healthcare visits per patient stratified by AD disease severity in: a Commercial, b Medicare, and c Medi-Cal populations. *P < 0.05. Variables included in the generalized linear model: age, gender, race, non-AD-related comorbidities, and region (Commercial and Medicare only). AD atopic dermatitis, ER emergency room

Fig. 7

Adjusted mean annual per-patient healthcare costs in AD patients and matched non-AD controls in the: a Commercial, b Medicare, and c Medi-Cal populations. *P < 0.05. Variables included in the generalized linear model: age, gender, race, non-AD-related comorbidities, and region (Commercial and Medicare only). AD atopic dermatitis, ER emergency room

Fig. 8

Adjusted mean annual per-patient healthcare costs stratified by AD disease severity in: a Commercial, b Medicare, and c Medi-Cal populations. *P < 0.05. Variables included in the generalized linear model: age, gender, race, non-AD-related comorbidities, and region (Commercial and Medicare only). AD atopic dermatitis, ER emergency room