Hidradenitis suppurativa patients are experiencing a surprising increase in comorbidities, costs and complications
Comorbidities are multiple medical conditions that a patient has. In the case of hidradenitis Suppurativa, these comorbidities cause the cost of the disease to continue to rise. HS is an inflammatory chronic skin condition that causes painful nodules and sinus tracts. It affects primarily areas with apocrine glands. As HS advances, it can lead to scarring, reduced mobility, depression and a decreased quality of living. In addition, HS is associated with a number of comorbid disorders including obesity, metabolic disease, diabetes, depression and autoimmune diseases.
This comorbidity increases healthcare costs for patients suffering from HS. In order to treat their condition, people with HS may need to undergo hospitalizations, surgeries, and long-term antibiotic treatments. Comorbid conditions can also increase the financial burden of treating HS patients, since they often need specialized care by different healthcare providers such as dermatologists and surgeons. The comorbidities of HS can also complicate management, making it harder to control symptoms and prevent the disease from progressing. The rising costs of comorbidities in HS patients are a burden to both the healthcare system as well as the individuals affected.
Amit Garg is a financial advisor to AbbVie. Aclaris Therapeutics. Anaptys Bio. Aristea Therapeutics. Bristol Myers Squibb. Incyte. InflaRx. Insmed. Janssen. Novartis. Pfizer. Sonoma Biotherapeutics. Union Therapeutics. For all relevant financial disclosures, please see the study.
The key takeaways
- Even after biologic therapy was approved, the comorbidity load continued to increase.
- The majority of patients are treated non-specialized health care providers.
According to a new study, comorbidities and health care costs are on the rise for patients with hidradenitis purpurativa. This calls for better disease management.
“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 Dermatology at the Donald & Barbara Zucker School of Medicine, Hofstra/Northwell and colleagues wrote. “Current registry data have suggested an increasing incidence in the United States.”
Adalimumab is not only increasing the incidence of HS, but it also increases the effectiveness of the treatment. the only biologic approved to treat HS, patients have limited treatment options. Garg, along with his colleagues, evaluated the clinical, socioeconomic, and sociodemographic characteristics of HS patients for a period of three years to improve management.
The retrospective study included 10230 adults (mean, age 47.1%; 69.8% females), 628 adolescents (15.3%; 84.9% girl) and 51 children younger than 12 with HS.
The results showed that all adolescents were covered by commercial insurance. 68.7% adults had commercial coverage and 31.3% Medicare.
Dermatologists (adults: 22.1%, adolescents: 30.6%) diagnose HS more often than general practitioners (adults: 41.6%, adolescents 39.6%).
Pre-index, diabetes without complications accounted for 20.4% of Charlson comorbidities among adults. The chronic pulmonary diseases (at 16.4%) and diabetes with complications (at 9%) were the next most common Charlson comorbidities among adults.
Comorbidities among adolescents were low, except for chronic lung disease which was 10.7% at the 2-year index. The researchers noted that the comorbidity in question was “likely asthma rather than chronic obstructive pulmonary disease.”
Elixhauser comorbidities like uncomplicated hypotension (38.3%), obese (22.5%) uncomplicated diabetics (19%) and depression (18.4%) are common in adult patients. These comorbidities have increased over the years.
All time periods, depression (11%), obesity (10) and chronic pulmonary diseases (8.3%) are high among adolescents. Depression and obesity increase over time.
Overall, the authors found the burden of comorbidity to be high and that it continued even after biologic therapy was approved.
Although surgical procedures are relatively rare, the most commonly used procedure among adults (7.6%), adolescents (6.4%) and children (5.6%) is incision and drainage.
The use of opioids by adults to treat pain related to HS was higher than that of adolescents.
Treatment with biologics was uncommon, as only 3.5% of adults used it and only 1.8% of teenagers.
Health care resource utilization, associated costs
At 1-year before the index, all patients reported high use of health care resources. The average number of visits for adults was 10.5 and for adolescents it was 6.9.
This study confirms that dermatology and surgical specialties are not the most common in-office or outpatient visits. Healio previously reported.
“This suggests a possible undermanagement of the disease, with patients being treated by non-specialist [health care providers],” Garg and co-workers 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.”
In the two-year period following the index, the total cost of health care for adults was $42,143 and for adolescents it was $16,057. Outpatient costs were the highest.