Healthcare Resource Utilization and Costs of Commercially Insured US Patients With Atopic Dermatitis Switching From First-Line to Second-Line Systemic Targeted Therapies
Author(s)
Kevin H. Li, PharmD, MS, Shelly L. Gray, PharmD, MS, Sean D. Sullivan, PhD.
The CHOICE Institute, University of Washington, Seattle, WA, USA.
The CHOICE Institute, University of Washington, Seattle, WA, USA.
OBJECTIVES: With the recent expansion of novel systemic targeted therapies to treat moderate-to-severe atopic dermatitis (AD), data on treatment switching and associated healthcare resource utilization (HCRU) and costs are limited. We evaluated the frequency of switching from first- to second-line systemic targeted therapies and compared HCRU and costs between switchers and non-switchers among commercially insured United States (US) patients with moderate-to-severe AD.
METHODS: We conducted a retrospective cohort study where adult patients with AD initiating a first systemic targeted therapy (index date) between January 1, 2022 and December 31, 2022 were identified and followed for at least one year from index date. Two cohorts were classified based on whether switching occurred over follow-up. All-cause and AD-related HCRU outcomes, including hospitalizations, emergency department (ED) visits, and outpatient services, and associated costs were compared between switchers and non-switchers during the follow-up period.
RESULTS: After a year following the initiation of first-line systemic targeted therapy, 466 (5.8%) switched to second-line systemic targeted therapy among the included 8,063 patients. Nearly all switchers (96.4%) had at least one AD-related outpatient service compared to 82.8% for non-switchers (p < 0.0001), and the mean number of visits was higher among switchers compared to non-switchers (5.12 vs. 3.20, p < 0.0001). AD-related hospitalizations and ED visits were rare. Mean total AD-related healthcare costs also were significantly higher among switchers compared to non-switchers ($63,245 vs. $53,004; p < 0.0001), with drug costs accounting for approximately 99% of AD-related healthcare expenditures in both groups.
CONCLUSIONS: These findings emphasize the increased importance of personalized considerations for the selection of first-line systemic targeted therapy for patients with moderate-to-severe AD to reduce downstream economic burden. As additional therapies become available, future research exploring reasons for treatment switching and patient factors influencing response will be critical to guide clinical and formulary decision-making in this evolving treatment landscape.
METHODS: We conducted a retrospective cohort study where adult patients with AD initiating a first systemic targeted therapy (index date) between January 1, 2022 and December 31, 2022 were identified and followed for at least one year from index date. Two cohorts were classified based on whether switching occurred over follow-up. All-cause and AD-related HCRU outcomes, including hospitalizations, emergency department (ED) visits, and outpatient services, and associated costs were compared between switchers and non-switchers during the follow-up period.
RESULTS: After a year following the initiation of first-line systemic targeted therapy, 466 (5.8%) switched to second-line systemic targeted therapy among the included 8,063 patients. Nearly all switchers (96.4%) had at least one AD-related outpatient service compared to 82.8% for non-switchers (p < 0.0001), and the mean number of visits was higher among switchers compared to non-switchers (5.12 vs. 3.20, p < 0.0001). AD-related hospitalizations and ED visits were rare. Mean total AD-related healthcare costs also were significantly higher among switchers compared to non-switchers ($63,245 vs. $53,004; p < 0.0001), with drug costs accounting for approximately 99% of AD-related healthcare expenditures in both groups.
CONCLUSIONS: These findings emphasize the increased importance of personalized considerations for the selection of first-line systemic targeted therapy for patients with moderate-to-severe AD to reduce downstream economic burden. As additional therapies become available, future research exploring reasons for treatment switching and patient factors influencing response will be critical to guide clinical and formulary decision-making in this evolving treatment landscape.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE512
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)