Impact of the Decline in the Number of Community Dermatologists in France on Treatment of Actinic Keratosis (EPIKA Study)
Author(s)
Brigitte Dreno, MD1, Pierre Levy, PhD2, Grégory Caillet, MD3, Amandine Gouverneur, Phd4, Jean-Michel JOUBERT, MD5, Jean-Michel AMICI, MD6.
1INSERM, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, UMR 1302/EMR6001, University of Nantes, Nantes, France, 2université Paris-Dauphine, Boulogne-Billancourt, France, 3Almirall SAS, Issy les Moulineaux, France, 4Real World Solutions, IQVIA, Courbevoie, France, 5Dr, Almirall SAS, PARIS, France, 6Bordeaux University Hospital, Bordeaux, France.
1INSERM, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, UMR 1302/EMR6001, University of Nantes, Nantes, France, 2université Paris-Dauphine, Boulogne-Billancourt, France, 3Almirall SAS, Issy les Moulineaux, France, 4Real World Solutions, IQVIA, Courbevoie, France, 5Dr, Almirall SAS, PARIS, France, 6Bordeaux University Hospital, Bordeaux, France.
OBJECTIVES: The spread of ‘medical deserts’, areas of territory with minimal specialist care provision, is a major challenge for public health policy in France. One area of concern is the decline in the number of community dermatologists, which may impact negatively the quality of care of common skin disorders, whose prevalence has not decrease concomitantly. This study aimed to document the relationship between the number of practicing dermatologists and the number of patients treated for actinic keratosis (AK) between 2014 and 2018.
METHODS: Information on the number of dermatologists practicing in France was obtained from the French Research and Statistics Bureau (DREES). All patients aged >40 years delivered a specific AK treatment between 01/01/2014 and 31/12/2019 were identified in the French National Health Insurance Database. Patients without AK treatment claims in the previous two years were considered newly-treated patients.
RESULTS: Between 2014 and 2018, the number of practicing dermatologists in France declined from 4,063 to 3,900, with a shift from community practice to hospital practice: the number of community dermatologists declined by 13% from 2,718 to 2,362. Waiting time to consult a dermatologist rose from 41 days to 61 days over the same period. Although the prevalence of AK is continually rising, the number of newly-treated patients fell from 77,814 in 2014 to 67,252 in 2018. The number of dermatologist consultations by patients treated for AK decreased by 25% from 21,720 in 2014 to 16,200 in 2018, and the number of consultations at which an AK treatment was prescribed decreased by 32% from 12,480 to 8,454. The number of General Practitioners (GPs) consultations over the same period remained stable.
CONCLUSIONS: Decreased availability of community dermatologists over the last decade has led to a decrease in AK treatment. Promoting transfer of AK care to the GP may compensate for this decline in care standards.
METHODS: Information on the number of dermatologists practicing in France was obtained from the French Research and Statistics Bureau (DREES). All patients aged >40 years delivered a specific AK treatment between 01/01/2014 and 31/12/2019 were identified in the French National Health Insurance Database. Patients without AK treatment claims in the previous two years were considered newly-treated patients.
RESULTS: Between 2014 and 2018, the number of practicing dermatologists in France declined from 4,063 to 3,900, with a shift from community practice to hospital practice: the number of community dermatologists declined by 13% from 2,718 to 2,362. Waiting time to consult a dermatologist rose from 41 days to 61 days over the same period. Although the prevalence of AK is continually rising, the number of newly-treated patients fell from 77,814 in 2014 to 67,252 in 2018. The number of dermatologist consultations by patients treated for AK decreased by 25% from 21,720 in 2014 to 16,200 in 2018, and the number of consultations at which an AK treatment was prescribed decreased by 32% from 12,480 to 8,454. The number of General Practitioners (GPs) consultations over the same period remained stable.
CONCLUSIONS: Decreased availability of community dermatologists over the last decade has led to a decrease in AK treatment. Promoting transfer of AK care to the GP may compensate for this decline in care standards.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH137
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)