Cost Reduction and Health Care Barriers: Atopic Dermatitis

In this feature interview, The Dermatologist met with Elisha Myers to discuss her recent study¹ on how physicians can take a multifaceted approach to atopic dermatitis (AD) treatment that reduces costs and health care barriers.

Elisha Myers is a student of the Center for Dermatology Research in the department of dermatology at the Wake Forest School of Medicine in Winston-Salem, NC.

How are treatment costs affected by patient education and severity of disease?

Myers: Education is important not only for improving the outcomes of the disease, but also for reducing costs. The main idea behind this is that we want to be sure patients are knowledgeable and aware of their disease and how to manage it effectively. That doesn't mean they're playing the physician, it just means they're effective. When they have corticosteroids at home, they're constantly moisturizing their skin, keeping that barrier in place, and reducing the number of flares. This is just making sure patients are aware of how to reduce these flares and teaching them which treatments are effective versus not effective. We see some patients using herbal remedies and things that haven't been shown to be as efficacious as other treatment methods such as corticosteroids. By teaching them what's better and what works well from the studies that we've done, we can educate our patients and make them better at treating their own disease.

Another big aspect of patient education is that there is a fear of corticosteroids. A lot of patients don't want to use them. They're concerned about long-term negative side effects of corticosteroids, so they'll either use them for a very short period of time or not really want to use them at all. By teaching them the effective nature of corticosteroids and the low risk of using them for [a longer] period of time, we can reduce costs because we can reduce the number of flares that patients have.

Overall, educating patients on their disease and effective treatments can reduce the number of flares that the patient has, thereby reducing not only the severity of the disease for the patient, but also reducing the cost because we're not having to reach for more expensive treatment measures. We know that the more severe the disease is, the more expensive the treatment options. Basically, the goal is to educate the patient, keep AD under control, and by default reduce the cost.

How can increasing patient medication adherence and moisturization between flares reduce costs in AD?

Myers: For AD in general, medical adherence to the medication, specifically topical medications, tends to be poor across the board. I previously mentioned corticosteroids; for several reasons, patients aren’t good about using these medications consistently. When they're not being used consistently, we get flares. For example, in patients who aren't moisturizing frequently, they get a big flare and then we have to treat it more aggressively. By teaching patients how to be adherent with their medications and use them consistently, we can reduce the number of flares, the need for hospital visits, the need for inpatient visits to the doctor's office, and costs.

Additionally, daily moisturizing and moisturizing at certain times in relation to when a person has been bathing can be effective in keeping and maintaining the skin barrier and reducing flares. Some studies have even suggested that if we prophylactically moisturize individuals who are at high risk for AD early on, we can reduce the chance of them ever presenting with AD in their life. Obviously, never having AD means the treatment costs are going to be significantly lower. That's another aspect behind moisturizing and how we can reduce costs.

Overall, medication adherence reduces the number of flares and the need for more severe and expensive medications, and it can reduce time off for office visits.

How can physicians take a multifaceted approach to AD treatment that reduces costs and health care barriers?

Myers: When considering AD treatment, it's challenging, and there are so many aspects to consider. You want to consider which medication is the most effective, the safest, and more affordable. Balancing all these aspects and deciding what treatment to use and individualizing that treatment plan are all [part of the] multifaceted approach.

For example, if you have a patient who's not a younger patient, but who might not be as adherent as an older patient, you have to adapt your approach to that patient and how you're going to treat them. Ideally, the most effective treatment is the one with the best safety profile or the lowest cost, but that doesn't always happen. Sometimes we need to reach first for the lowest cost [medication] and see if it works. At some points, we might need to use a more expensive medication. In severe cases of AD, although the more expensive medication might have a big initial price tag, overall it would reduce the cost if the disease is severe enough.

Considering and tailoring a treatment approach to each individual patient is key. Also, I think a big part is just taking 10 minutes to talk to the patient and educate them on their disease, especially when it's just being diagnosed. Spending that little time to teach them about the disease can have major impacts on the patient's disease severity and how they live with the disease because it is a difficult disease to live with.

What else would you like to share with your colleagues regarding cost reduction in AD?

Myers: Eczema is a condition where the cost is incredibly burdensome to the health care system. It's a very common disease, and many people have it, but it’s an incredibly expensive disease. As health care providers, we all have a responsibility to practice good health care spending. With limited health care resources , we want to maximize the resources we have and make sure that we're using those resources effectively. I think every patient provider, especially someone treating AD, but honestly any condition, should always be considering the broader health care system and how they are doing their part in reducing spending and maximizing the health care resources that we do have.

Reference
Myers EM, Perche PO, Jorizzo JL, Feldman SR. Reducing costs in atopic dermatitis. Dermatol Ther. 2022;35(11):e15849. doi:10.1111/dth.15849