Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermato­logical Practice in Two German Federal States

Authors

  • Daniela Weiss
  • Imke Nordhorn
  • Linda Tizek
  • Thomas Werfel
  • Alexander Zink
  • Tilo Biedermann
  • Stephan Traidl
  • Maximilian C. Schielein Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, DE-80802 Munich, Germany

DOI:

https://doi.org/10.2340/00015555-3901

Keywords:

biological therapy, dermatology, healthcare costs, prescriptions, patient-centred care, skin diseases

Abstract

The globally increasing prevalence of chronic inflammatory skin diseases has substantial costs. Biologicals have become available as therapeutic options, but are encumbered with barriers to prescription. The aim of this study was to evaluate the barriers to prescription of biologicals in the treatment of chronic dermatological diseases. Dermatologists working in private practices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional study. Economic and legal aspects, including “high therapy costs”, “low reimbursements”, and “fear of regress claims”, were identified as the most prevalent barriers. Significant differences between dermatologists from Bavaria and Lower Saxony were found only regarding the treatment of atopic dermatitis. This study demonstrates the prevalence of barriers to the prescription of biologicals in the treatment of chronic dermatological diseases. Overcoming these barriers could improve the usage of modern therapies and thereby expand patient-centred care for chronic skin diseases.

Downloads

Download data is not yet available.

References

Deckers IA, McLean S, Linssen S, Mommers M, van Schayck CP, Sheikh A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990–2010: a systematic review of epidemiological studies. PLoS One 2012; 7: e39803.

Balp MM, Weller K, Carboni V, Chirilov A, Papavassilis C, Severin T, et al. Prevalence and clinical characteristics of chronic spontaneous urticaria in pediatric patients. Pediatr Allergy Immunol 2018; 29: 630–636.

Radtke MA, Schafer I, Glaeske G, Jacobi A, Augustin M. Prevalence and comorbidities in adults with psoriasis compared to atopic eczema. J Eur Acad Dermatol Venereol 2017; 31: 151–157.

Zink A, Herrmann M, Fischer T, Lauffer F, Garzorz-Stark N, Bohner A, et al. Addiction: an underestimated problem in psoriasis health care. J Eur Acad Dermatol Venereol 2017; 31: 1308–1315.

Zink A, Ruth M, Schuster B, Darsow U, Biedermann T, Ständer S. Pruritus in Deutschland – eine Google-Suchmaschinenanalyse. Hautarzt 2019; 70: 21–28.

Zink A, Schuster B, Ruth M, Pereira MP, Philipp-Dormston WG, Biedermann T, et al. Medical needs and major complaints related to pruritus in Germany: a 4-year retrospective analysis using Google AdWords Keyword Planner. J Eur Acad Dermatol Venereol 2019; 33: 151–156.

Parisi R, Rutter MK, Lunt M, Young HS, Symmons DPM, Griffiths CEM, et al. Psoriasis and the risk of major cardiovascular events: cohort study using the clinical practice research datalink. J Invest Dermatol 2015; 135: 2189–2197.

Schielein MC, Tizek L, Schuster B, Ziehfreund S, Biedermann T, Zink A. Genital psoriasis and associated factors of sexual avoidance – a people-centered cross-sectional study in Germany. Acta Derm Venereol 2020; 100: adv00151.

Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, et al. Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33: 1331–1340.

Schuster B, Ziehfreund S, Albrecht H, Spinner CD, Biedermann T, Peifer C, et al. Happiness in dermatology: a holistic evaluation of the mental burden of skin diseases. J Eur Acad Dermatol Venereol 2020; 34: 1331–1339.

Karimkhani C, Boyers LN, Naghavi M, Coffeng LE, Lott JP, Wulf S, et al. The global burden of disease associated with alopecia areata. Br J Dermatol 2015; 172: 1424–1426.

Zink AGS, Arents B, Fink-Wagner A, Seitz IA, Mensing U, Wettemann N, et al. Out-of-pocket costs for individuals with atopic eczema: a cross-sectional study in nine European countries. Acta Derm Venereol 2019; 99: 263–267.

Zink A. The financial impact of atopic eczema paid out-of-pocket by affected patients in France. J Eur Acad Dermatol Venereol 2019; 33: 1817.

Eckert L, Gupta S, Amand C, Gadkari A, Mahajan P, Gelfand JM. The burden of atopic dermatitis in US adults: health care resource utilization data from the 2013 National Health and Wellness Survey. J Am Acad Dermatol 2018; 78: 54–61.e1.

Launois R, Ezzedine K, Cabout E, Reguai Z, Merrhand S, Heas S, et al. Importance of out-of-pocket costs for adult patients with atopic dermatitis in France. J Eur Acad Dermatol Venereol 2019; 33: 1921–1927.

Sawyer LM, Wonderling D, Jackson K, Murphy R, Samarasekera EJ, Smith CH. Biological therapies for the treatment of severe psoriasis in patients with previous exposure to biological therapy: a cost-effectiveness analysis. Pharmacoeconomics 2015; 33: 163–177.

Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 2018; 32: 850–878.

Nast A, Amelunxen L, Augustin M, Boehncke WH, Dressler C, Gaskins M, et al. S3 Guideline for the treatment of psoriasis vulgaris, update – short version part 2 – special patient populations and treatment situations. J Dtsch Dermatol Ges 2018; 16: 806–813.

Wedi B, Traidl S. Anti-IgE for the treatment of chronic urticaria. Immunotargets Ther 2021; 10: 27–45.

Nast A, Spuls PI, van der Kraaij G, Gisondi P, Paul C, Ormerod AD, et al. European S3-Guideline on the systemic treatment of psoriasis vulgaris – update apremilast and secukinumab – EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2017; 31: 1951–1963.

Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73: 1393–1414.

Augustin M, Eissing L, Langenbruch A, Enk A, Luger T, Maassen D, et al. The German national program on psoriasis health care 2005–2015: results and experiences. Arch Dermatol Res 2016; 308: 389–400.

Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 2018; 73: 1284–1293.

D’Angiolella LS, Cortesi PA, Lafranconi A, Micale M, Mangano S, Cesana G, et al. Cost and cost effectiveness of treatments for psoriatic arthritis: a systematic literature review. Pharmacoeconomics 2018; 36: 567–589.

Gutknecht M, Reinert R, Augustin M. Review of health economic analyses in atopic dermatitis: how diverse is the literature? Expert Rev Pharmacoecon Outcomes Res 2019; 19: 127–145.

Nast A, Mrowietz U, Kragballe K, de Jong EM, Puig L, Reich K, et al. Barriers to the prescription of systemic therapies for moderate-to-severe psoriasis – a multinational cross-sectional study. Arch Dermatol Res 2013; 305: 899–907.

Grellmann C, Dombrowsky W, Fabricius V, Suruki R, Sheahan A, Joeres L. Epidemiology and treatment of patients with rheumatoid arthritis, psoriatic arthritis and psoriasis in Germany: a real-world evidence study. Adv Ther 2021; 38: 366–385.

Schielein MC, Tizek L, Rotter M, Konstantinow A, Biedermann T, Zink A. Guideline-compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria. J Eur Acad Dermatol Venereol 2018; 32: 978–984.

Eissing L, Radtke MA, Zander N, Augustin M. Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 2016; 30: 569–575.

Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, et al. Psoriasis and comorbid diseases: implications for management. J Am Acad Dermatol 2017; 76: 393–403.

Seegraber M, Srour J, Walter A, Knop M, Wollenberg A. Dupilumab for treatment of atopic dermatitis. Expert Rev Clin Pharmacol 2018; 11: 467–474.

Honstein T, Werfel T. The show must go on: an update on clinical experiences and clinical studies on novel pharmaceutical developments for the treatment of atopic dermatitis. Curr Opin Allergy Clin Immunol 2020; 20: 386–394.

Puig L. Incremental cost per responder (PASI-75, PASI-90 and PASI-100) based on a network meta-analysis of biologic therapies for psoriasis: Spain 2018. Actas Dermosifiliogr 2019; 110: 517–518.

Puig L, Lopez-Ferrer A, Vilarrasa E. Incremental cost-effectiveness ratio analysis of biologic treatments for psoriasis at clinically significant evaluation time points. Actas Dermosifiliogr 2014; 105: 951–953.

Gu T, Shah N, Deshpande G, Tang DH, Eisenberg DF. Comparing biologic cost per treated patient across indications among adult us managed care patients: a retrospective cohort study. Drugs Real World Outcomes 2016; 3: 369–381.

Wu JJ, Feldman SR, Rastogi S, Menges B, Lingohr-Smith M, Lin J. Comparison of the cost-effectiveness of biologic drugs used for moderate-to-severe psoriasis treatment in the United States. J Dermatolog Treat 2018; 29: 769–774.

Constantin MM, Cristea CM, Taranu T, Bucur S, Constantin T, Dinu A, et al. Biosimilars in dermatology: the wind of change. Exp Ther Med 2019; 18: 911–915.

Blankart KE, Arndt F. Physician-level cost control measures and regional variation of biosimilar utilization in Germany. Int J Environ Res Public Health 2020; 17: 4113.

Dzubur E, Khalil C, Almario CV, Noah B, Minhas D, Ishimori M, et al. Patient concerns and perceptions regarding biologic therapies in ankylosing spondylitis: insights from a large-scale survey of social media platforms. Arthritis Care Res (Hoboken) 2019; 71: 323–330.

Lima XT, Seidler EM, Lima HC, Kimball AB. Long-term safety of biologics in dermatology. Dermatol Ther 2009; 22: 2–21.

Kamata M, Tada Y. Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review. Int J Mol Sci 2020; 21: 1690.

Berenson RA, Ginsburg PB, May JH. Hospital-physicians relations: cooperation, competition, or separation? Health Aff (Millwood) 2007; 26: w31–43.

Additional Files

Published

2021-09-28

How to Cite

Weiss, D., Nordhorn, I., Tizek, L., Werfel, T., Zink, A., Biedermann, T., Traidl, S., & Schielein, M. C. (2021). Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermato­logical Practice in Two German Federal States. Acta Dermato-Venereologica, 101(9), adv00560. https://doi.org/10.2340/00015555-3901