Where you live matters: Regional differences in health care resource use for psoriasis in the United States - 25/02/20

Doi : 10.1016/j.jaad.2019.10.014

Khoa B. Nguyen, BS ^a, Charlotte Read, MBBS, BSc ^b,^c, Kevin K. Wu, BA ^d, April W. Armstrong, MD, MPH ^b,^⁎
^a University of Central Florida College of Medicine, Orlando, Florida
^b Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, California
^c Department of Medicine, Imperial College London, London, United Kingdom
^d Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut

^∗Correspondence to: April W. Armstrong, MD, MPH, University of Southern California, 1975 Zonal Ave, KAM 510, MC 9034, Los Angeles, CA 90089.University of Southern California1975 Zonal Ave, KAM 510, MC 9034Los AngelesCA90089

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 25 February 2020

Abstract

Background

It is unknown which U.S. Census region offers the best access to health care resources.

Objective

To compare health care resource use and costs for patients with psoriasis among the 4 U.S. Census regions.

Methods

Cross-sectional study using the 1996-2015 Medical Expenditure Panel Survey.

Results

In the United States the greatest access for biologic medications was in the South (9.1% receiving biologic medications/year), followed by the Northeast (7.4%), the West (6.8%), and the Midwest (5.2%). Ambulatory visits per patient per year were highest in the West (5.02), followed by the Northeast (3.81), the South (2.95), and the Midwest (2.84). The proportion of patients with ≥1 emergency department (ED) visits was highest in the Northeast (2.73%), followed by the West (2.17%), the South (1.19%), and the Midwest (1.17%). Compared with the remainder of the country, the West incurred the lowest total health care costs (P = .035) and the lowest drug costs (P = .023); and the Northeast incurred the highest total health care costs (P = .050) and the highest ambulatory costs (P < .001). Although the South had the greatest proportion of patients using biologic medications (9.1% vs 6.4%, P = .045), it also had 30% fewer ambulatory visits per patient per year and a 39% lower proportion of ED visits for psoriasis.

Limitations

Data for psoriasis severity were unavailable.

Conclusions

Southern U.S. states have the greatest access to biologic medications and incurred fewer ambulatory and ED visits. The Midwest had the lowest access to biologic medications and ambulatory and ED care. The West incurred the lowest total health care costs, while the Northeast incurred the highest total health care costs.

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Key words : biologics, costs, disparity, health care resources, location, Medical Expenditure Panel Survey, population study, psoriasis, regions, United States

Abbreviations used : CI, ED, MEPS, PPPY

Plan

Methods

Data source and population selection

Variables

Data analysis

Results

Overall U.S. health care resource use and costs

West versus rest of the United States

South versus rest of the United States

Midwest versus rest of the United States

Northeast versus the rest of the United States

Other sensitivity analyses

Discussion

Conclusions

	Funding sources: None.
	Conflicts of interest: Dr Armstrong has served as an investigator and advisor to AbbVie, Janssen, Lilly, Pfizer, UCB, Dermira, Dermavant Sciences, Novartis, Kyowa Hakko Kirin (KHK), Ortho Dermatologics, Sanofi, Regeneron, and Modernizing Medicine. The other authors have no conflicts of interest to declare.
	IRB approval status: Reviewed and approved by University of Southern California institutional review board (approval IIR00002254).
	Reprints not available from the authors.