Socioeconomics of atopic dermatitis and new therapies

April 8, 2019

Happy spring everyone! For most of us, spring allergy season is in full “bloom”! I know it is a busy time in the clinic as many patients (both new and established) are trying to get in to see us. But hopefully you will reserve some down time to relax and recharge. A good and useful activity is reading the April issue of the Annals of Allergy, Asthma and Immunology. This month’s issue emphasizes socioeconomic aspects of allergy/immunology practice. Some may think socioeconomic concerns only apply to patients who do not have insurance or are otherwise socially disadvantaged. However, with the literal explosion on the market of new and very expensive therapies for many of the conditions we treat such as asthma, atopic dermatitis, hereditary angioedema and others, even insured patients often face challenges. These challenges include prior authorization disapproval, prohibitively large copays and even availability at retail vs. mail order sources. All of these impact the ultimate utility of many of our new therapies.

In this month’s Annals, Michael S. Blaiss, MD, FACAAI has authored a perspective that can serve as a model in thinking about the cost-benefit for expensive new therapies. He describes the issues, using atopic dermatitis (AD) as an example, within the context of disease prevalence, personal and societal burden as well as quality-of-life issues weighed against product cost.  This also has to be weighed as research that addresses the heterogeneity of AD is revealing a phenotypic spectrum that will have differential response rates to specific interventions. More knowledge as to selection and expectation of time needed for response will be major factors going forward as we move further into this new therapeutic area of technologically advanced, but highly expensive, therapies.

In the CME review article for this month, Janice Chung, BS and Eric L. Simpson, MD, MCR further explore the socioeconomics of AD. They review data that examine socioeconomic status (SES) and AD risk which is further complicated by data that suggest the incidence of AD may actually be greater with higher SES. A thorough discussion of the possibilities has applicability to other atopic diseases. Although prevalence may be positively correlated with SES, AD is more severe when it occurs in patients of lower SES. This raises the question of altered effectiveness of some of these new drugs with the increased price tag that may not be as effective in more severe disease. The authors provide real data regarding direct and indirect costs of AD to ponder as we, the prescribing physicians, consider the impact of these factors on optimal management for all patients with AD.

I hope you will enjoy reading these and other features in the April Annals issue. I welcome your comments about what we have published and other things not published that you might like to see. As always, feel free to contact me at gmarshall@umc.edu.

Gailen D. Marshall, Jr., MD, PhD, FACAAI
Editor-in-chief