New Study Underscores High Economic and Comorbidity Burden for Patients with PN

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A recent retrospective analysis, presented at Fall Clinical 2024 in Las Vegas, Nevada, from October 24 to 27, reported that patients of prurigo nodularis (PN) suffer from high economic and comorbidity burdens.¹ The study examined insurance costs, treatment methods, and coexisting conditions in patients diagnosed between 2017 and 2022.

Background

According to the poster, prevalence estimates for PN in the US range from 36.7 to 148.3 per 100,000 people.² Therapies such as topical corticosteroids, systemic corticosteroids, systemic immunosuppressants, and modern biologic therapies can help manage painful symptoms.

Currently, the pathophysiology of PN is poorly understood, as there are complicated interactions between the body’s immune and nervous systems as well as tissue remodeling pathways. There is also a lack of real-world data that analyzes comorbidity burden, healthcare costs, and treatment utilization.

Methods and Materials

The study utilized data from the MerativeMarketScanCommercialand Medicare Database from January 1, 2016, to June 30, 2023. This included a 12-month pre-index period that measured the demographic and clinical characteristics of participants. It also measured outcomes regarding treatment utilization, healthcare costs, and comorbid conditions during a post-index period.

Participants were matched 3:1 into a PN cohort (n = 10,411) and a control group (n = 31,233). In the PN cohort, 55% of patients were female with a mean age of 53.8 and an average Charlson Comorbidity Index (CCI) score of 1. Individual patient costs were calculated via insurer payments and patient cost-sharing.

“After matching, the PN cohort and controls were well balanced on most demographic and clinical characteristics measured pre-index,” the authors wrote.

Results

The most common treatments recorded were topical corticosteroids (55%), corticosteroid injections (44%), antidepressants (38%), oral corticosteroids (27%), and benzodiazepines (22%). Among patients with PN, 10% were treated with topical therapy only, 79% received systemic therapy, and 11% received no treatment. There were fewer patients in the high-cost cohort with no treatment compared with the full PN cohort.

Versus the control group, patients with PN had significantly higher costs, with an overall difference of $5,736 per patient. This was primarily due to outpatient services and pharmacy costs. Overall, 1,050 patients were identified as having high all-cause healthcare costs. These patients were older, with a mean age of 57.6, and had a higher CCI score (2.4) compared to the overall PN cohort. Patients in this group had total healthcare costs of $116,239. This was comprised of outpatient services costs (45%), inpatient services (27%), and pharmacy prescriptions (28%).

In the post-index period, patients with PN were much more likely to have been newly diagnosed with a comorbidity including an atopic or other relevant dermatologic condition, attention deficit disorder, autism, COPD, infection, autoimmune disease, metabolic/cardiovascular disease, mental health condition, or sleep disorder (p < 0.001).

According to the multivariate logistic regression model, patients with PN with high healthcare costs had increased odds of having other chronic conditions such as renal disease, malignancy, cardiovascular disease, and type 2 diabetes as well as many PN-related comorbid conditions including infections, anxiety, depression, sleep disorders, and other autoimmune diseases (p < 0.05).

Limitations

This analysis did not include patients with employer-sponsored Medicare or other non-commercial types of health insurance. It also did not include those without health insurance, which may alter cost data. Additionally, the MarketScan Research Databases rely on insurance claims data, which could have been entered and classified incorrectly.

Conclusion

Overall, patients with PN had a higher incidence of comorbidities and, thus, higher healthcare costs, compared to the matched controls. Researchers noted that more effective measures are needed to address these burdens in this patient population.

“Treatment patterns show many patients with PN are receiving treatment for the mental health symptoms of PN, but more patients could potentially benefit from available systemic treatment options that target autoimmune or anti-inflammatory aspects of the disease,” the authors wrote.

References

1. Elmariah SB, Princic N, Richards M, et al. Economic and Comorbidity Burden of Prurigo Nodularis and Drivers of Higher Healthcare Costs in the US: A Retrospective Analysis of Claims Data of Patients Diagnosed between 2017 and 2022. Poster presented at the 44th Annual Fall Clinical Dermatology Conference. Las Vegas, Nevada. October 24 to 27, 2024.

2. 2. Ständer S, Augustin M, Berger T, et al. Prevalence of prurigo nodularis in the United States of America: A retrospective database analysis. JAAD Int. 2021;2:28-30.