Comorbidity Burden Continues to Rise After Diagnosis of Hidradenitis Suppurativa

In a recent non-interventional cohort study, investigators found that comorbidity burden continues to rise after a diagnosis of hidradenitis suppurativa (HS) in adults and adolescents.¹ The authors used Optum’s de-identified Clinformatics Data Mart Database from January 1, 2016-December 31, 2018, to assess the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU), and associated costs of patients with HS after biologic approval.

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The study of 10,909 adults (≥18) and adolescents (12-17) who met the study criteria measured comorbidities, treatment, procedure patterns, HCRU, and associated costs during the 1-year pre-index period (excluding the index date) and 1- and 2-years post-index period (including the index date). Comorbidities included Charlson comorbidities, Charlson Comorbidities Index (CCI), Elixhauser comorbidities, and Elixhauser Comorbidities Index (ECI), among others.

HCRUs and associated costs were measured during the same period as comorbidities and assessed all-cause and HS-specific HCRUs including office visits to dermatologists and surgeons; “other outpatient visits, emergency room (ER) and hospitalizations; healthcare costs comprising all-cause and HS-specific ER costs; all-cause and HS-specific inpatient costs; all-cause and HS-specific outpatient costs; all-cause and HS-specific medical costs (inpatient, outpatient and ER); all-cause and HS prescription drug costs; all-cause and HS-related total healthcare costs (medical cost and prescription drug cost).”¹

The most common comorbidities in adult patients were diabetes without complications, chronic pulmonary disease, diabetes with complications, peripheral vascular disease, renal disease, obesity, hypertension, uncomplicated diabetes, depression, and chronic pulmonary disease, all of which increased over the 3 years of the period studied. Depression, acne, and obesity increased over time in adolescent patients.

In the 2-year post-index period, total healthcare cost (total medical plus total prescription) for adults was $42,143 and for adolescents was $16,057, of which outpatient costs were highest for both groups. All-cause dermatology office visits and HS-specific overall visits were higher for the adolescent group than for the adult group.

Study authors suggest that early treatment or identification of patients could help mitigate the costs associated with HS. Their analysis showed that the majority of these patients were treated with topical therapies and systemic antibiotics, and that most of the office visits were to offices other than dermatology offices. This suggests that the disease could be undermanaged, as treatment of HS by a clinician other than a dermatologist could result in a lack of effective treatment, misdiagnosis, or a delay in diagnosis.

These patients did exhibit high comorbidities, however, and were diagnosed with additional comorbidities, suggesting that good primary and secondary care are needed for diagnosis and management.

When assessing HCRU, outpatient medical costs accounted for a greater proportion of overall costs in both adults and adolescents.

Study authors suggest that a multidisciplinary approach to management of HS could help improve HS patient care as well as help to control costs associated with the disease.

Reference

1. Garg A, Geissbühler Y, Houchen E, et al. Disease burden and treatment patterns among US patients with hidradenitis suppurativa: A retrospective cohort study. Am J Clin Dermatol. June 28, 2023. https://doi.org/10.1007/s40257-023-00796-2