Systemic Therapy of Atopic Dermatitis in Germany: Real-World Data on Care Structures and Economic Implications in a Retrospective Longitudinal Study

OBJECTIVES: Atopic dermatitis (AD) is a prevalent dermatological disease often beginning in childhood, manifesting with potentially severe symptoms. Beyond topical therapies, a range of systemic therapies with varying HTA outcomes and pricing structures are now available to appropriate patients in Germany. AD imposes in Germany and across Europe high direct and indirect costs, which have gained new dynamics through systemic therapies. This ongoing study aims to identify and analyze the actual care pathways and existing cost structures in AD therapy in Germany.

METHODS: The retrospective longitudinal study utilizes pseudonymized prescription data, outpatient care data, and master data obtained from the Association of Statutory Health Insurance Physicians of Westphalia-Lippe from 2018 to 2023, covering 7.5 million people (9% of Germany). All patients with a confirmed AD diagnosis (M2Q criterion) are included. In addition to a descriptive evaluation of the current care situation, a differentiated longitudinal analysis of patients receiving systemic therapy is conducted.

RESULTS: In 2023, 157,664 AD patients (50,379 < 18 years) were identified, corresponding to a prevalence of 2.1%. Of these, 3.9% (5.4% ≥ 18 years, 0.7% < 18 years) received systemic therapy with total medication costs of approximately €109 million. The total prescription costs of systemic AD therapy increased by 39% from 2018 to 2023, with an 18% increase in patients. The proportion of patients receiving biologicals increased from 39.2% (2018) to 54% (2023). The proportion of JAK inhibitor patients nearly doubled from 4.9% (2018) to 7.7% (2023). Further results, particularly regarding patient pathways, will follow.

CONCLUSIONS: The initial results indicate a significant change in the use of systemic therapies among AD patients in recent years, leading to considerable economic implications. Understanding actual treatment pathways from real-world data in a healthcare system without formal reimbursement restrictions can help identify medically and economically meaningful treatment pathways and sequences.