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McPherson T, Cork MJ, Goodhead C, Michaelis LJ, Flohr C, Petrovic M, Hennessy L, Rajkovic I, Hudson R. A real-world retrospective observational study exploring NHS resource use in England for the management of moderate-to-severe atopic dermatitis in secondary care for children and adolescents. Pediatr Dermatol 2023; 40:50-63. [PMID: 36127813 DOI: 10.1111/pde.15134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To describe secondary care health care resource utilization (HCRU) for children and adolescents with atopic dermatitis (AD). PATIENTS AND METHODS This UK chart review of patients with moderate-to-severe AD was conducted in four National Health Service hospitals. Cohorts were defined by age (children 6-11 years, adolescents 12-17) at first consultation. Eligible patients were selected consecutively, starting with the most recently consulting patient. At least 12 months' data were abstracted from medical records. Data were collected on HCRU, demographics/clinical characteristics, treatment, and patient-reported outcomes. RESULTS Data were abstracted for 55 patients. Most patients (80%) had severe AD at first referral, a mean (SD) of 3.2 (10.7) patient-reported flare episodes/patient/year-of-observation, and 18.5 (16.7) tests/scans/procedures/patient/year. Mean (SD) observation duration was 3.6 (1.8) years. Patients had tried mean (SD) 7.9 (5.3) treatments/patient/year of observation. Topical corticosteroids (TCS; 24.5% of prescriptions) were most frequently prescribed. Mean (SD) use of emollients/moisturizers, TCS, systemic corticosteroids, and systemic immunosuppressants was 30.9 (21.3), 21.1 (23.4), 1.7 (8.3), and 7.8 (8.2) months. There was a mean (SD) of 5.3 (2.9) consultations/patient/year-of-observation; 116 (10.7%) for flare. Most hospitalizations (87.5%) were for children; the 8/55 (15%) hospitalized patients (mean 2.0 hospitalizations/patient during observation period) spent 6.2 (SD: 5.1) nights in hospital/hospitalization. Earliest mean (SD) Children's Dermatology Life Quality Index score was 15.3 (7.2); latest was 12.9 (7.5). CONCLUSION Children and adolescents with moderate-to-severe AD had a high HCRU burden and small changes in quality of life, indicating that current treatments may provide suboptimal AD control in most cases.
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Affiliation(s)
- Tess McPherson
- Oxford University Hospitals NHS Foundation Trust, Headlington, UK
| | - Michael J Cork
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | | | - Carsten Flohr
- Guy's & St Thomas' NHS Foundation Trust & King's College London, London, UK
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Secular Trends of Influenza Vaccination Do Not Account for Trends of Atopic Dermatitis in US Children. Dermatitis 2021; 32:e143-e144. [PMID: 34807542 DOI: 10.1097/der.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miles LM, Ducharme FM, Collin J, Blais L, Bacon SL, Lavoie KL, McKinney ML, Peláez S. Physician's perspective regarding asthma guided self-management: directives or guidance? J Asthma 2021; 59:1263-1268. [PMID: 33877960 DOI: 10.1080/02770903.2021.1914652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma guided self-management enhances patients' control of their condition under the guidance of the treating physician. The aim of the present study was to understand how physicians perceive, endorse, uptake, and support asthma guided self-management. METHODS We conducted a secondary supplementary analysis of data originally collected as part of a multicenter collective case study in which physicians treating patients with asthma were interviewed. Using reflective thematic analysis, we aimed to explore physicians' understanding of guided asthma self-management as related to four ideas, namely: (a) understanding of the disease management and treatment goals; (b) defining medical frame and guidance; (c) describing the importance of patient-physician relationship; and (d) implementing asthma guided self-management. RESULTS Evidence indicates that physicians perceived optimal guided self-management as related to patients' adherence to physician's instructions and recommendations, supported by the adjustment of prescribed pharmaceutical therapy contingent upon patient's symptoms. Some physicians also perceived behavior change and environmental control along with the medical recommendations. While physicians' perception of asthma and its treatment were aligned with the recommended guidelines-i.e., patient-centered care approach based on guided self-management, the actual guidance offered to patients remained primarily directive and paternalistic. Non-pharmacological approaches, such as exercise, smoking cessation, patient self-monitoring, and self-management supported by education and written self-management plans, were given little consideration in the context of the recommended treatment plan.
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Affiliation(s)
- Laura May Miles
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Collin
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,School of Kinesiology and Physical Activity Sciences (EKSAP), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Ortsäter G, Geale K, Dun AR, Cappelleri JC, Cha A, Romero W, Henrohn D, Neregard P, Neary MP. Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case-Control Study in Sweden. Dermatol Ther (Heidelb) 2020; 11:161-172. [PMID: 33337521 PMCID: PMC7859158 DOI: 10.1007/s13555-020-00470-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by pruritic, eczematous lesions. Recent evidence suggests that AD may be a systemic disorder, implying that management of this disease extends beyond merely controlling symptoms associated with AD. Even though this disease is highly prevalent in children and patients typically present with mild-to-moderate symptoms, the disease burden is not well established. Methods A large, retrospective cohort study of Swedish population data was conducted to compare the clinical burden in terms of healthcare resource use and direct medical costs for pediatric mild-to-moderate (pM2M) AD patients (≤ 14 years of age, N = 87,721) with matched controls. The burden of a severe AD cohort was also evaluated. Severity of AD was defined by treatment usage and systemic treatment was used as a proxy for severe AD. A robust approach was used by including any type of secondary care visits known to be more common in AD patients than in the general population; however, data for primary care visits were not available. Results For healthcare resource use, the incidence rate ratio (pM2M AD versus reference cohort) of secondary care visits ranged from 1.56 to 2.35 during each of 5 years after AD onset (all p < 0.001), with largest differences seen in years 1–2. The average direct medical cost (SD) was €1111 (3416) and €524 (2446) in the pM2M AD and reference cohorts, respectively. The corresponding estimate in the severe AD cohort was €1906 (7067). Including all secondary care visits and pharmacy-dispensed medications, the pM2M AD cohort was shown to have an additional €118.9 million in direct medical costs over 5 years compared with the reference cohort. Conclusions This study shows significant clinical and economic burden of pM2M AD with important secondary care resource utilization, suggesting a need for further research to increase treatment options and improve the management of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-020-00470-z.
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Affiliation(s)
| | - Kirk Geale
- Quantify Research AB, Stockholm, Sweden
- Dermatology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Joseph C Cappelleri
- Global Biometrics and Data Management (Statistics), Pfizer Inc, Groton, CT, USA
| | - Amy Cha
- Inflammation and Immunology, Pfizer Inc, New York, NY, USA
| | | | - Dan Henrohn
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Petra Neregard
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Maureen P Neary
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
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Berg AK, Thorsen SU, Thyssen JP, Zachariae C, Keiding H, Svensson J. Cost of Treating Skin Problems in Patients with Diabetes Who Use Insulin Pumps and/or Glucose Sensors. Diabetes Technol Ther 2020; 22:658-665. [PMID: 31800294 DOI: 10.1089/dia.2019.0368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The use of insulin pump and glucose sensor is advantageous, but unfortunately many experience skin problems. To reduce or overcome skin problems, patients use additional products or change their sets preterm. Therefore, the aim was to investigate costs related to skin problems. Materials and Methods: Two hundred sixty-three patients from four different hospitals in Denmark participated in a cross-sectional survey about skin problems related to insulin pump and/or glucose sensor use. Additional costs aside technology and diabetes treatment were calculated based on adhesives, patches, lotion, and preterm shifts of infusion or sensor sets due to skin problems. Descriptive statistics and linear regression were used. Results: The total costs for all these expenses were 11493.9 U.S. dollars (USD) in 145 pediatric patients and 4843 USD in 118 adult patients. The costs were higher in patients with, than without, skin problems and for skin problems due to the glucose sensor compared with insulin pump. Pediatric patients with eczema and/or wound due to the glucose sensor did cost 154.3 USD more, than patients without these skin problems (P < 0.01). We found a clear dose/response relationship between costs and severity of skin problems, especially in pediatric patients. Conclusions: Our data show that skin problems due to use of insulin pump and/or glucose sensor have significant costs on the Danish welfare system. This leaves an economic incentive for developing more skin-sensitive adhesive for the infusion set and sensors, at least for a certain subgroup of patients.
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Affiliation(s)
- Anna Korsgaard Berg
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Medical and Health Science, University of Copenhagen, Kobenhavn, Denmark
| | - Steffen Ullitz Thorsen
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Hans Keiding
- Department of Economics, University of Copenhagen, Kobenhavn, Denmark
| | - Jannet Svensson
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Medical and Health Science, University of Copenhagen, Kobenhavn, Denmark
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Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study. PLoS One 2019; 14:e0224544. [PMID: 31665167 PMCID: PMC6821095 DOI: 10.1371/journal.pone.0224544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 10/16/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To describe the temporal development of mortality and health service utilisation defined as in- and outpatient hospital contacts, contacts with general practitioner and specialists, and prescribed dispensed medication among Danish children 0-5 years of age from 1999 to 2016. DESIGN Register-based descriptive study. PARTICIPANTS All children born in Denmark in the period 1994-2016 followed until 5 years of age. MAIN OUTCOME MEASURES Annual incidence rates of mortality and health service utilisation outcomes, and incidence rate ratios compared to the reference calendar year 1999. The new measure of post-discharge mortality is presented. RESULTS Post-discharge mortality decreased from 1999 to 2016, IRR2016 = 0.49 (95% CI: 0.36 to 0.66). Total contacts did not change much over time, IRR2016 = 1.02 (1.02 to 1.03), but increased among neonates, IRR2016 = 3.69 (3.63 to 3.75), and decreased among children with chronic disease IRR2016 = 0.94 (0.93 to 0.94). In- and out-patient hospitalisations increased, IRR2016 = 1.26 (1.24-1.27) resp. IRR2016 = 1.62 (1.60-1.63), contacts with medical specialists increased, IRR2016 = 1.43 (1.42 to 1.43), whilst contacts with general practitioner decreased, IRR2016 = 0.91 (0.91 to 0.91). Medication use decreased, IRR2016 = 0.82 (0.82 to 0.82). CONCLUSIONS Our measure of post-discharge mortality was halved during the study period indicating improved health. Overall health service utilisation did not change much, but the type of utilisation changed, and the development over time differed between subgroups defined by age and chronic disease status. Our findings call for considerations about the benefit of increased specialisation and increased use of health services among 'healthy' children not suffering from chronic disease.
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Nurse's perceptions on infection prevention and control in atopic dermatitis in children. Infect Dis Health 2019; 24:141-146. [DOI: 10.1016/j.idh.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
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Sach TH, McManus E, Levell NJ. Understanding economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol 2019; 181:707-716. [PMID: 30693473 PMCID: PMC6790711 DOI: 10.1111/bjd.17696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
Background Atopic eczema is an inflammatory skin condition, with a similar impact on health‐related quality of life as other chronic diseases. Increasing pressures on resources within the National Health Service increase the importance of having good economic evidence to inform their allocation. Objectives To educate dermatologists about economic methods with reference to currently available economic evidence on eczema. Methods The role of different types of economic evidence is illustrated by evidence found in a systematic literature search conducted across 12 online databases up to 22 May 2017. Primary empirical studies either reporting the results of a cost‐of‐illness study or evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema were included. Two reviewers independently assessed studies for eligibility and performed data abstraction, with disagreements resolved by a third reviewer. Evidence tables of results were produced for narrative discussion. The reporting quality of economic evaluations was assessed. Results Seventy‐eight studies (described in 80 papers) were deemed eligible. Thirty‐three (42%) were judged to be economic evaluations, 12 (15%) cost analyses, six (8%) utility analyses, 26 (33%) cost‐of‐illness studies and one a feasibility study (1%). The calcineurin inhibitors tacrolimus and pimecrolimus, as well as barrier creams, had the most economic evidence available. Partially hydrolysed infant formula was the most commonly evaluated prevention. Conclusions The current level of economic evidence for interventions aimed at preventing and treating eczema is limited compared with that available for clinical outcomes, suggesting that greater collaboration between clinicians and economists might be beneficial. What's already known about this topic? Resources available for health care are limited and their efficient allocation should be informed by robust economic evidence about value for money. The scale and quality of economic evidence available for atopic eczema has not previously been examined.
What does this study add? By comparison with the considerable clinical evidence for interventions to prevent and treat eczema, there is limited economic evidence available. The economic evidence available is limited in scope with regard to the types and range of interventions evaluated. The quality of future economic studies could be improved by greater collaboration between economists and clinicians.
https://doi.org/10.1111/bjd.18391 available online
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Affiliation(s)
- T H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - E McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, U.K
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Gutknecht M, Reinert R, Augustin M. Review of health economic analyses in atopic dermatitis: how diverse is the literature? Expert Rev Pharmacoecon Outcomes Res 2018; 19:127-145. [DOI: 10.1080/14737167.2019.1549491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mandy Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rabea Reinert
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Increased healthcare utilisation among atopic children in a general practice database: a nested index-control study. BJGP Open 2018; 2:bjgpopen18X101349. [PMID: 30564702 PMCID: PMC6181076 DOI: 10.3399/bjgpopen18x101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background Atopic eczema, asthma, and allergic rhinitis (AR) create a serious burden on general practice resources. Aim To investigate the use of general practice resources (that is, consultation visits, telephone contacts, and home visits) in children with physician-diagnosed atopic disorders (ADs). Design & setting In a nested index-control study design, all children (here defined as individuals aged 2–18 years) listed in a representative general practice database were selected in 2014. Method Children diagnosed with ADs were matched on age and sex with non-atopic controls within the same practice. For all the different groups, the number and frequency of children contacting the GP were calculated. Results Of the children with atopic eczema (n = 15 202), 80% consulted the GP in 2014 (controls = 67%). Of the children with asthma (n = 7754), 80% consulted the GP (controls = 65%), and for children with AR (n = 6710), this was 82% (controls = 66%). Of the children with all three ADs, 91% consulted the GP (controls = 68%). On average, a child with atopic eczema contacted the GP 2.8 times/year (controls = 1.9); for children with asthma, the contact frequency was 3.0 (controls = 1.9); and for AR, 3.2 (controls = 1.9). For children with all three ADs, the contact frequency was 4.3 (controls = 2.0). Consultations related to the ADs investigated only explain a smaller part of the increased healthcare utilisation in atopic children. Conclusion Atopic children use more general practice resources compared to non-atopic children, yet frequently for morbidity or other health-related questions not related to one of the ADs.
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