33843 Atopic dermatitis polypharmacy and out-of-pocket health care expenses in the United States

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Background: Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with out-of-pocket (OOP) expenses in AD is poorly understood. Objective: To characterize prescription polypharmacy and its association with OOP health care expenses among individuals with AD. Methods: An online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (U.S. resident, age ≥18, self-reported or caregiver of individual with AD) was met by 77.3% (1118/1447) of respondents. Results: Polypharmacy (≥5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits (HCP), and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P ≤ .01). Polypharmacy was also associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor use (P ≤ .0005). Respondents with polypharmacy had increased OOP expenditures across numerous categories including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P < .005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs, and more harmful household financial impact (P < .0001 for all). Similar results were observed with a less stringent definition of polypharmacy (≥3 prescription treatments). Conclusion: Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and significant financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes.