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Epidemiology of pruritus in France
Epidemiology of pruritus in France
(Poster reference number 4859) Laurent Misery, MD, Chu Brest, Brest, France; Charles-Remy Taieb, PhD, Pierre Fabre, Boulogne Billancourt, France Objective: The epidemiology of pruritus is not well known, as it has been subject to little study in France. Methods: A representative sample of the population was taken by the CSA-HealthInstitute. One thousand seven hundred and three subjects completed a questionnaire on itching, its frequency and intensity. Results: The prevalence of pruritus is 29.8%. For 3.5% of the population asked, itching is frequent, whereas 13% rarely experience itching. Incidence of itching was 9.5%. The evening and night are the times at which itching is most intense. The scalp, back, legs, and arms are the most frequently itchy areas of the body, with 47.5%, 32.1%, 28.4%, and 25% of subjects reporting them, respectively. Nine percent would rate their itching as intense or unbearable. Forty percent of subjects found their itching to be more intense when lying down or at rest. Ninety percent of subjects felt their itching on the surface, and 9% deeper under the skin. Discussion: Pruritus affects around one-third of the French population over a period of 1 year, and 10% in the last week. These statistics are similar to those gained from studies in Norway and Germany. The intensity is variable, but pruritus is nevertheless an undeniable public health issue. Commercial support: 50% sponsored by Laboratoires Ducray.
Landscape of biologic formulary management and patient access in psoriasis
(Poster reference number 5128)
C. T. Carter, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; A. Naim, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; K. Annunziata, Kantar Health, New York, NY, United States; S. Martin, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States Background: Health plans may use a variety of strategies to manage the costs of biologics used in the treatment of psoriasis (PsO). Other factors, in addition to the biologic cost, may impact treatment access and refill patterns, from the patient’s perspective. Objective: To describe health plan formulary management strategies for biologics used in PsO and evaluate the types of costs associated with filling biologic prescriptions, from the patient perspective. Methods: Data were generated from the United States WPAI Recontact Study, administered to an Internet panel of self-identified PsO patients (aged $ 18 years), February-March 2009 and May-June 2010. Health insurance type, benefit design, and types of costs associated with filling biologic drugs used for PsO were collected. Results: A total of 498 PsO patients (mean age, 46 years; 57% female). The majority of patients (90%) reported currently having health insurance. The top three types of health insurance were identified by patients as employer-paid (44%), managed care (34%), and health maintenance organization (21%). Of those patients with current health insurance (n ¼ 449), 96% reported having PsO prescription medication coverage and 39% needed a referral to see a specialist. Copay or coinsurance was required for 93% of patients. Of all PsO patients, 135 were biologic users (96% reported having health insurance). Of biologic users, injectable/intravenous PsO medication coverage was reported as follows: 32% had coverage with higher copay, 28% had coverage with same copay as other medications, and 18% had coverage of the total expense. The patient cost of the biologic prevented 24% of biologic users from filling the medication at some point. The most frequently reported ancillary costs (beyond the cost of the biologic) associated with filling the biologic, from the patient perspective, were multiple visits to health care providers (36%), number of refills (28%), multiple visits to pharmacy (24%), and gas/tolls (18%). Conclusion: The majority of PsO patients in the United States have health insurance with PsO medication coverage. Copay and coinsurance were common features of these health plan benefit designs. Patients considered other economic aspects, such as frequency of refills and visits to health care providers/pharmacy, as being associated with filling biologic prescriptions. Clinicians are encouraged to consider these behavioral economic aspects in shared PsO treatment decision-making. Commercial support: Centocor Ortho Biotech Services, LLC.
Experience with the dermatology inpatient hospital service at Mayo Clinic over a decade
(Poster reference number 4817)
Eoin Storan, MBBCh, Mayo Clinic, Rochester, MN, United States; Alina Bridges, DO, Mayo Clinic, Rochester, MN, United States; David Wetter, MD, Mayo Clinic, Rochester, MN, United States; Marian McEvoy, MBBCh, Mayo Clinic, Rochester, MN, United States; Mark Davis, MD, Mayo Clinic, Rochester, MN, United States; Michael Camilleri, MD, Mayo Clinic, Rochester, MN, United States; Rokea elAzhary, MD, Mayo Clinic, Rochester, MN, United States Background: A diminishing number of hospitals in the United States have a dedicated inpatient dermatology service. There is a paucity of published data describing dermatology inpatient dermatology services. At Mayo Clinic, we have had a dedicated dermatology inpatient service to which patients with severe dermatoses are admitted. Aims: To examine patient demographics and lengths of stay of adult patients admitted to the dermatology inpatient hospital service over a decade and examine the trends over the years, comparing the data between the first 5 years and the second 5 years. Methods: A retrospective study looking at dermatology inpatients specifically examining patient demographics, lengths of stay, and indications for admission to the adult dermatology inpatient service over the past decade at Mayo Clinic (20002010). Data were extracted from electronic records. Distributions of continuous and categorical variables between the 2 time periods were compared using the Wilcoxon rank sum and the x2 tests, respectively. Results: A total of 1747 patients had 2233 inpatient admissions to the adult dermatology hospital inpatient service between 2000 and 2010; 51% (n ¼ 1138) were female. The mean (SD) age was 61 (18) years. Ninety-four percent (1844/1961) were white. The median duration of admission was 3 days (interquartile range [IQR], 2-5). Thirty-nine percent (871) of admissions were for patients from within the state of Minnesota; 32.7% (730) were from the surrounding states of ND, SD, IA, IL, and WI; 26.8% (598) were from the rest of the United States; the remaining 1.5% (34) were from outside the United States. Patients were admitted for a wide range of dermatoses. We compared admissions from 2000 to 2005 (n ¼ 1269) to admissions from 2005 to 2010 (n ¼ 964). The age and gender distributions of the patients admitted were not statistically significantly different; however, the proportion of nonwhite patients increased (7.4% vs 4.8%; P ¼ .02). In addition, a statistically significant difference was noted with respect to median length of stay (decreased from 4 days [IQR, 3-6] to 3 days [IQR, 2-4]).
Necrolytic acral erythema in the setting of a patient with known hepatitis C virus infection but undiagnosed alcohol addiction
(Poster reference number 5180)
Conclusion: The dermatology inpatient services at Mayo Clinic provides inpatient dermatologic care to patients with severe dermatologic disease from not only the local area but patients who have traveled from the surrounding states, nationally and internationally; almost two-thirds of patients admitted to hospital were from outside Minnesota. The median length of stay has decreased between the two time periods.
Alexis Dougherty, MD, Texas Tech University Health Science Center, Department of Dermatology, Lubbock, TX, United States; Michael Wells, MD, Texas Tech University Health Science Center, Department of Dermatology, Lubbock, TX, United States Fewer than 10 cases of necrolytic acral erythema (NAE) have been reported in patients living in modern, ‘‘Western’’ countries to date. While screening for underlying hepatitis C virus (HCV) infection and zinc deficiency have been advocated in patients presenting with NAE, screening for alcohol addiction (AA) has not been addressed. AA is a known risk factor the development of zinc deficiency in adult patients living in ‘‘Western’’ countries. We describe a case report of NAE in the setting of known HCV infection but undiagnosed alcohol addiction. Because appropriate AA treatment can prove life-saving, we advocate that dermatologists consider screening for AA in adult patients presenting with NAE, especially in patients living in ‘‘Western’’ countries. Multiple theories have been offered to explain the epidemiologic variance of NAE including HCV strain and patient’s immune status; although NAE may prove rare in ‘‘Western’’ countries, because concomitant HCV infection and zinc deficiency are rare in ‘‘Western’’ countries.
Commercial support: None identified.
Commercial support: None identified.
AB88
J AM ACAD DERMATOL
APRIL 2012
(Poster reference number 4859) Laurent Misery, MD, Chu Brest, Brest, France; Charles-Remy Taieb, PhD, Pierre Fabre, Boulogne Billancourt, France Objective: The epidemiology of pruritus is not well known, as it has been subject to little study in France. Methods: A representative sample of the population was taken by the CSA-HealthInstitute. One thousand seven hundred and three subjects completed a questionnaire on itching, its frequency and intensity. Results: The prevalence of pruritus is 29.8%. For 3.5% of the population asked, itching is frequent, whereas 13% rarely experience itching. Incidence of itching was 9.5%. The evening and night are the times at which itching is most intense. The scalp, back, legs, and arms are the most frequently itchy areas of the body, with 47.5%, 32.1%, 28.4%, and 25% of subjects reporting them, respectively. Nine percent would rate their itching as intense or unbearable. Forty percent of subjects found their itching to be more intense when lying down or at rest. Ninety percent of subjects felt their itching on the surface, and 9% deeper under the skin. Discussion: Pruritus affects around one-third of the French population over a period of 1 year, and 10% in the last week. These statistics are similar to those gained from studies in Norway and Germany. The intensity is variable, but pruritus is nevertheless an undeniable public health issue. Commercial support: 50% sponsored by Laboratoires Ducray.
Landscape of biologic formulary management and patient access in psoriasis
(Poster reference number 5128)
C. T. Carter, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; A. Naim, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; K. Annunziata, Kantar Health, New York, NY, United States; S. Martin, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States Background: Health plans may use a variety of strategies to manage the costs of biologics used in the treatment of psoriasis (PsO). Other factors, in addition to the biologic cost, may impact treatment access and refill patterns, from the patient’s perspective. Objective: To describe health plan formulary management strategies for biologics used in PsO and evaluate the types of costs associated with filling biologic prescriptions, from the patient perspective. Methods: Data were generated from the United States WPAI Recontact Study, administered to an Internet panel of self-identified PsO patients (aged $ 18 years), February-March 2009 and May-June 2010. Health insurance type, benefit design, and types of costs associated with filling biologic drugs used for PsO were collected. Results: A total of 498 PsO patients (mean age, 46 years; 57% female). The majority of patients (90%) reported currently having health insurance. The top three types of health insurance were identified by patients as employer-paid (44%), managed care (34%), and health maintenance organization (21%). Of those patients with current health insurance (n ¼ 449), 96% reported having PsO prescription medication coverage and 39% needed a referral to see a specialist. Copay or coinsurance was required for 93% of patients. Of all PsO patients, 135 were biologic users (96% reported having health insurance). Of biologic users, injectable/intravenous PsO medication coverage was reported as follows: 32% had coverage with higher copay, 28% had coverage with same copay as other medications, and 18% had coverage of the total expense. The patient cost of the biologic prevented 24% of biologic users from filling the medication at some point. The most frequently reported ancillary costs (beyond the cost of the biologic) associated with filling the biologic, from the patient perspective, were multiple visits to health care providers (36%), number of refills (28%), multiple visits to pharmacy (24%), and gas/tolls (18%). Conclusion: The majority of PsO patients in the United States have health insurance with PsO medication coverage. Copay and coinsurance were common features of these health plan benefit designs. Patients considered other economic aspects, such as frequency of refills and visits to health care providers/pharmacy, as being associated with filling biologic prescriptions. Clinicians are encouraged to consider these behavioral economic aspects in shared PsO treatment decision-making. Commercial support: Centocor Ortho Biotech Services, LLC.
Experience with the dermatology inpatient hospital service at Mayo Clinic over a decade
(Poster reference number 4817)
Eoin Storan, MBBCh, Mayo Clinic, Rochester, MN, United States; Alina Bridges, DO, Mayo Clinic, Rochester, MN, United States; David Wetter, MD, Mayo Clinic, Rochester, MN, United States; Marian McEvoy, MBBCh, Mayo Clinic, Rochester, MN, United States; Mark Davis, MD, Mayo Clinic, Rochester, MN, United States; Michael Camilleri, MD, Mayo Clinic, Rochester, MN, United States; Rokea elAzhary, MD, Mayo Clinic, Rochester, MN, United States Background: A diminishing number of hospitals in the United States have a dedicated inpatient dermatology service. There is a paucity of published data describing dermatology inpatient dermatology services. At Mayo Clinic, we have had a dedicated dermatology inpatient service to which patients with severe dermatoses are admitted. Aims: To examine patient demographics and lengths of stay of adult patients admitted to the dermatology inpatient hospital service over a decade and examine the trends over the years, comparing the data between the first 5 years and the second 5 years. Methods: A retrospective study looking at dermatology inpatients specifically examining patient demographics, lengths of stay, and indications for admission to the adult dermatology inpatient service over the past decade at Mayo Clinic (20002010). Data were extracted from electronic records. Distributions of continuous and categorical variables between the 2 time periods were compared using the Wilcoxon rank sum and the x2 tests, respectively. Results: A total of 1747 patients had 2233 inpatient admissions to the adult dermatology hospital inpatient service between 2000 and 2010; 51% (n ¼ 1138) were female. The mean (SD) age was 61 (18) years. Ninety-four percent (1844/1961) were white. The median duration of admission was 3 days (interquartile range [IQR], 2-5). Thirty-nine percent (871) of admissions were for patients from within the state of Minnesota; 32.7% (730) were from the surrounding states of ND, SD, IA, IL, and WI; 26.8% (598) were from the rest of the United States; the remaining 1.5% (34) were from outside the United States. Patients were admitted for a wide range of dermatoses. We compared admissions from 2000 to 2005 (n ¼ 1269) to admissions from 2005 to 2010 (n ¼ 964). The age and gender distributions of the patients admitted were not statistically significantly different; however, the proportion of nonwhite patients increased (7.4% vs 4.8%; P ¼ .02). In addition, a statistically significant difference was noted with respect to median length of stay (decreased from 4 days [IQR, 3-6] to 3 days [IQR, 2-4]).
Necrolytic acral erythema in the setting of a patient with known hepatitis C virus infection but undiagnosed alcohol addiction
(Poster reference number 5180)
Conclusion: The dermatology inpatient services at Mayo Clinic provides inpatient dermatologic care to patients with severe dermatologic disease from not only the local area but patients who have traveled from the surrounding states, nationally and internationally; almost two-thirds of patients admitted to hospital were from outside Minnesota. The median length of stay has decreased between the two time periods.
Alexis Dougherty, MD, Texas Tech University Health Science Center, Department of Dermatology, Lubbock, TX, United States; Michael Wells, MD, Texas Tech University Health Science Center, Department of Dermatology, Lubbock, TX, United States Fewer than 10 cases of necrolytic acral erythema (NAE) have been reported in patients living in modern, ‘‘Western’’ countries to date. While screening for underlying hepatitis C virus (HCV) infection and zinc deficiency have been advocated in patients presenting with NAE, screening for alcohol addiction (AA) has not been addressed. AA is a known risk factor the development of zinc deficiency in adult patients living in ‘‘Western’’ countries. We describe a case report of NAE in the setting of known HCV infection but undiagnosed alcohol addiction. Because appropriate AA treatment can prove life-saving, we advocate that dermatologists consider screening for AA in adult patients presenting with NAE, especially in patients living in ‘‘Western’’ countries. Multiple theories have been offered to explain the epidemiologic variance of NAE including HCV strain and patient’s immune status; although NAE may prove rare in ‘‘Western’’ countries, because concomitant HCV infection and zinc deficiency are rare in ‘‘Western’’ countries.
Commercial support: None identified.
Commercial support: None identified.
AB88
J AM ACAD DERMATOL
APRIL 2012