OBJECTIVES: Prurigo Nodularis (PN) is a rare chronic inflammatory dermatosis with itchy skin nodules and lacking real-world-evidence-data. This study aimed to describe the increased burden for PN and to assess the related economic effects on the health care system using real-world data compared to a Benchmark (BM) population.

METHODS: This retrospective study is based on an excerpt of German Statutory Health Insurance (SHI) data. PN cohort included SHI-insured patients from 2010 to 2018 defined by an initial PN diagnosis (ICD-10-GM L28.1) during a selection period 2012-2016 (index quarter = InQ), no record of PN in 8 quarters before InQ and a follow-up (FU) of 8 quarters or deceased. BM cohort without PN was calculated via direct standardization and matched 1:1 to the PN cohort.

RESULTS: Out of 4,536,002 SHI-insured, 2,309 incident PN patients were identified and matched to the BM cohort out of 3,018,382 persons without PN. Newly diagnosed PN patients were mostly between 45-80 years. Significant higher co-morbidity rates were reported for PN compared to BM with a rising disease burden in FU. About 90% of PN patients were diagnosed outpatient showing 50% more outpatient visits than BM. Hospitalization rates were higher in PN versus BM (53.88% vs 35.12%) yielding twice longer mean hospital stays for PN compared to BM (12 vs 6 days). Mean initial costs were two-fold higher in PN versus BM for outpatient (330.15€ vs 149.54€), inpatient (760.38€ vs 320.55€), and drugs (352.50€ vs 179.94€). In FU, an increase of >70% mean PN costs compared to BM were identified for outpatient (2,186.39€ vs 1,263.01€), inpatient (4,600.24€ vs 2,678.13€), and drugs (2,840.48€ vs 1,513.48€). Therapy rates were significantly higher for PN compared to BM.

CONCLUSIONS: This study highlights the significantly higher clinical and economic burden incurred by PN compared to BM in Germany considering the high unmet medical need for PN.