Where you live matters: Regional differences in health care resource use for psoriasis in the United States

Abstract

It is unknown which U.S. Census region offers the best access to health care resources. To compare health care resource use and costs for patients with psoriasis among the 4 U.S. Census regions. Cross-sectional study using the 1996-2015 Medical Expenditure Panel Survey. 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. Data for psoriasis severity were unavailable. 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.