OBJECTIVES: Prurigo nodularis (PN) is a rare neuroimmune condition characterized by thick itchy skin nodules, inflammation, and fibrosis. Treatment guidelines are lacking, although the landscape is changing with newly approved and late-stage targeted therapies. This study used US claims data to describe treatment utilization and comorbidities and to identify drivers of and quantify healthcare costs among PN patients versus matched controls.

METHODS: Patients with >2 diagnoses of PN were selected from the MarketScan databases (1/1/2017- 6/30/2022) for this retrospective analysis (earliest diagnosis = index). Controls had no evidence of PN or atopic dermatitis (AD). Both PN cases and controls had a 12-month baseline and follow-up. Direct and propensity score matching were used to balance cases and controls (1:3) on (5) baseline demographic and (29) clinical characteristics, respectively. PN treatments were described during the follow-up. The incidence of comorbid conditions and healthcare costs were compared among cases and controls. Subgroup analyses of high-cost patients (the top 10% for all-cause and PN-related costs) were performed.

RESULTS: There were 10,411 patients (N = 1,050 high-cost cohort) with PN and 31,233 matched controls (mean age 53.8, 55% female, standardized differences 0.000; mean 1.0-1.1 Charlson comorbidity score, standardized difference 0.073). Among patients with PN, 10.1% were treated with topicals only, 78.8% with systemic therapy (2.1% dupilumab), and 11.1% received no treatment. 12 months after diagnosis, compared with controls, patients with PN were more likely (p<0.001) to have been newly diagnosed with (non-AD) atopic conditions, infections, autoimmune diseases, metabolic/cardiovascular diseases, mental health conditions, and sleep disorders, and their healthcare costs amounted to $20,968 per-person ($5,736 [p<0.001] higher compared with controls, driven primarily by outpatient services [difference; $2,856] and pharmacy costs [difference; $2,357]).

CONCLUSIONS: Patients with PN (vs. controls) had significantly higher incidence of comorbidities and healthcare costs, warranting more effective measures to address the health and financial burden of PN.