Review Examines Different Ways to Reduce Costs for Atopic Dermatitis Treatment

A recent review illuminated the varying ways in which costs for atopic dermatitis (AD) treatment can be reduced for populations in need.

The review was conducted by Elisha M. Myers, BS, and Patrick O. Perche, BS, with the Wake Forest School of Medicine Center for Dermatology Research. Their research team sought to explore the ways in which treatment costs for AD can be reduced given specific education and resources, especially with regard to underserved populations.

Myers and colleagues took advantage of available resources to examine the various ways in which AD patients can receive treatment and management with costs and limited means in mind. AD is known to disproportionately affect children as well as minority groups.

The investigators conducted their review using GoodRx and WebMD to ascertain drug prices. They also used the PubMed search engine for AD guidelines, using a set of keywords to attain the necessary data:

• Atopic dermatitis
• Cost
• Medications
• Treatment
• Management
• Efficacy
• Adherence
• Education
• Prophylactic

Prophylactic Therapy

The research team also found that prophylactic therapy through moisturizer use may reduce later costs for AD patients. In studies on newborns with high-risk of AD, the investigators noted that full-body moisturizing for a 6 - 8 month duration starting within the first few weeks of life for this group reduced disease instances significantly.

The investigators added that intermittent prophylactic corticosteroids or a non-corticosteroid medication for maintenance therapy may be preferable if moisturizing is not enough.

Mild-to-Moderate AD

The investigators noted that in patients “with mild to moderate disease experiencing an AD flare, topical corticosteroids are the first-line treatment and should be started as soon as possible.” They added that if reducing cost is a concern for patients, then they recommend beginning with safe and less expensive medications, seeing how AD responds to them, and then escalating treatment if required.

The researchers found that mild to moderate cases of AD in patients may be served best through greater information about AD flare up triggers, given that the costs of things like medication, provider visits, and work absences can add up. Knowledge about ways to avoid exacerbating factors may promote cost reduction for AD patients.

Moderate-to-Severe AD

The research team noted that those with moderate-to-severe AD require treatment options like methotrexate, phototherapy, dupilumab, cyclosporine , and oral JAK inhibitors like abrocitinib and upadacitinib. These vary in cost widely. One way to reduce cost and increase adherence is home-based phototherapy, which the investigators cite as comparable with in-office phototherapy.

The investigators wrote that “cyclosporine may be better suited in the treatment of flares, but from a cost-conscious perspective, an oral prednisone taper may be as effective and cost much less…For long-term use, methotrexate may not be the most effective of all these options, but its low cost makes it a desirable medication from a cost-conscious perspective.”

The researchers also noted in their review that Dupilumab and JAK inhibitors, while highly-effective for AD patients, are exceptionally expensive. They add that policy changes may be needed in the healthcare industry to reduce these costs.

Patient Education

The investigators note in their review that educating AD patients on corticosteroid use, on managing exacerbations, on increasing moisturization, and on the lack of evidence for certain therapies over others, can contribute to reduced cost as well.

“When treating AD several treatment approaches are available, but when cost reduction is a primary objective, starting with less costly treatments initially and only escalating treatment as needed may be appropriate,” they wrote. “Alternatively, providers may find it more appropriate to start a patient with the most effective and safest treatment regimen first to reduce the duration of a flare and overall disease burden.”

This study, “Reducing Costs in Atopic Dermatitis,” was published on Wiley Online Library.