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An evaluation of the current treatment pathways and associated NHS resource use for the management of uncontrolled moderate-to-severe atopic dermatitis in secondary care
Objectives
To evaluate the hospital resource use and treatment pathways associated with management of adult patients with moderate-to-severe atopic dermatitis (AD) in the United Kingdom (UK) National Health Service (NHS)
Methods
A retrospective non-interventional study, involving data collected from hospital medical records of eligible consenting adult (≥21 years) patients with AD deemed uncontrolled on systemic therapy according to current UK standards of care was carried out in 6 secondary/tertiary centres within the UK NHS. Data related to patient demographic and clinical characteristics, and AD-related hospital resource utilisation and treatment were collected for up to 3 years prior to data collection point (August–December 2017). Summary measures were calculated per patient-year for the 2 year period prior to data collection point.
Results
Fifty-nine patients (69.5% male; mean age at diagnosis 10.3 [standard deviation (SD)=15.7] years; mean duration of AD 29.9 [SD=16.1] years) were evaluated for a total of 107 patient-years of follow-up. Patients attended a mean of 6.6 (SD=5.2) dermatology outpatient visits per patient-year; the majority were with a dermatologist (mean 6.1 [SD=5.1] visits per patient-year). Patients had a mean of 0.2 (SD=1.0) day-case visits, 0.1 (SD=0.3) Emergency Department attendances and 0.1 (SD=0.7) inpatient admissions per patient-year. Patients were prescribed a mean of 1.5 (SD=1.8) courses of systemic therapy (21 patients initiated ≥1 course of ciclosporin), 0.1 (SD=0.2) courses of phototherapy and 2.1 (SD=2.2) non-systemic treatments per patient-year (26/59 patients initiated ≥5 different treatment combinations [range 1–14] in 2 years). A mean of 1.6 (SD=1.3) flares per patient-year were recorded.
Conclusions
We observed a considerable burden of hospital visits, in particular dermatology outpatient visits, and complex treatment pathways in UK adults with moderate-to-severe AD. The number of flares experienced by patients despite complex treatment patterns suggests a lack of effective long-term treatment options for patients with moderate-to-severe AD.
Authors
M Ameen, S George, C Harwood, R Weller, J Lear, R Hudson, R Rout, K Halsby, A Bewley
Journal
Value in health
Therapeutic Area
Dermatology
Center of Excellence
Real-world Evidence & Data Analytics
Year
2018
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