OBJECTIVES : According to guideline recommendations, systemic therapy is indicated in patients with moderate-severe atopic dermatitis (AD) refractory to adequate topical treatment. In addition to extensive health impairment associated with more intense healthcare resource utilization (HCRU), those patients often experience a considerable negative impact on quality of life. Currently, there is a lack of real world evidence on the AD-related medical care situation and economic scope in Germany. The following study analyzed the influence of systemic therapy initiation on HCRU in AD patients with focus on disease-related drug treatment, associated costs and epidemiology.

METHODS : This study was conducted in a retrospective cohort design using aggregated pseudonymized German health claims data from the InGef database. A cohort of AD patients with systemic therapy initiation in 2017 was observed over a period of one year before and after initiating systemic treatment, respectively. HCRU and associated costs were analyzed and compared between baseline and observation period.

RESULTS : In 2018, the prevalence of AD was 4% (thereof 10% patients with systemic therapy). In the study cohort of patients with index systemic therapy (n=9,975), most patients (>99%) received systemic corticosteroids as index therapy. 96.9% of those discontinued their index systemic therapy (mean time to discontinuation: 46.3 days, SD=58.42). 41.6% received topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI) as well. Although use of TCS and/or TCI was less frequent, intensity of drug use was higher in the observation period compared to the baseline period. HCRU was significantly higher after systemic therapy initiation; mainly driven by medication, outpatient services and sick leave. AD patients incurred higher mean annual total costs (3,822€ vs. 3,092€) after systemic therapy initiation.

CONCLUSIONS : The study demonstrates a high burden imposed by AD with relevant impact on HCRU and considerable associated costs as well as an unmet need to further improve systemic drug treatment for AD patients.