Acta Dermato-Venereologica 99-4CompleteContent | Page 7

370 CLINICAL REPORT Healthcare Service Utilization by 116,816 Patients with Atopic Dermatitis in Israel Guy SHALOM 1,2 , Meir BABAEV 2 , Khalaf KRIDIN 3 , Yochai SCHONMANN 4–6 , Amir HOREV 7 , Jacob DREIHER 2 , Michal SHANI 5,8 , Shmuel TIOSANO 9 , Shani FISHER 10 , Doron COMANESHTER 5,8 and Arnon D. COHEN 2,5,8 1 Clalit Health Services, Yavne, 2 Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 3 Department of Dermatology, Rambam Health Care Campus, Haifa, Israel, 4 Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, 5 Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Clalit Health Services, 6 Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel, 7 Pediatric unit, Department of Dermatology and Venereology, Soroka Medical Center; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8 Department of Quality Measurements and Research, Chief Physician’s Office, Clalit Health Services, Tel-Aviv, 9 Department of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, and 10 Department of Dermatology, HaEmec MC, Afula, Israel Understanding of the epidemiology and healthcare ser- vice utilization related to atopic dermatitis is necessary to inform the use of new treatments. This cross-sectio- nal study was based on a group of patients with atopic dermatitis and a matched control group comprised of age- and sex- matched enrolees without atopic derma- titis from a large medical database. Healthcare service utilization usage data were extracted and compared bet- ween groups. The study included 116,816 patients with atopic dermatitis and 116,812 controls. Atopic dermati- tis was associated with an increased burden of health- care utilization across the entire spectrum of healthcare services compared with controls. For patients severely affected by atopic dermatitis, the increased burden cor- related with disease severity: a high­ er frequency of emergency room visits (odd ratio (OR) 1.7; 95% confi- dence interval (CI) 1.6–1.9), dermatology wards hospi- talizations (OR 315; 95% CI 0–7,342), and overall hos- pitalizations (OR 3.6; 95% CI 3.3–3.9). In conclusion, this study demonstrates an increased burden of health- care utilization in atopic dermatitis. Key words: atopic dermatitis; healthcare service utilization; epidemiology. Accepted Jan 16, 2019; E-published Jan 22, 2018 Acta Derm Venereol 2019; 99: 370–374. Corr: Guy Shalom, Clalit Health Services, 2 nd Snapir St., 8155211 Yavne, Israel. E-mail: [email protected] A topic dermatitis (AD) is a common chronic non- contagious relapsing inflammatory skin disorder. The current prevalence of AD in most high-income and some low-income countries is approximately 10–30% in children and 2–10% in adults (1, 2), yet data regarding healthcare service utilization and drug use in patients with AD are lacking. Until recently, the treatment choices for AD were limited, especially for severe AD. Treatments include long-term emollients and topical steroids as first- line therapy, followed by topical calcineurin inhibitors. Systemic treatments for AD may include antihistamines, but consist mainly of steroids, methotrexate, ciclosporin, azathioprine, mycophenolate mofetil, or phototherapy. doi: 10.2340/00015555-3117 Acta Derm Venereol 2019; 99: 370–374 SIGNIFICANCE Treatment arsenal for atopic dermatitis has expanded dra- maticly during last years. To allow the incorporation of the newly introduced, expensive treatments the epidemiology and healthcare service utilization of patients with atopic dermatitis must be defined in a timely manner. We report an increased burden of healthcare utilization across the entire spectrum of healthcare services in a large group of 116,816 patients with atopic dermatitis compared with con- trols without atopic dermatitis. Increased emergency room visits, hospitalizations in dermatology wards, and overall hospitalizations were found. A dose-response manner ac- cording to disease severity was observed. All of these have proven effective and can be successful in moderate-to-severe disease (3–6). Insights regarding the pathogenesis of AD during re- cent years, have led to the introduction of breakthrough treatments, leading to considerable changes in treatment modalities for AD. Defining the epidemiology, healthcare service utilization, and drug use of patients with AD is necessary to inform the use of these newly introduced treatments. This study investigated the demographic and epidemiological characteristics, healthcare service utili- zation, and drug usage of a large group of patients with AD in Israel, selected from the medical database at Clalit Health Services (CHS). PATIENTS AND METHODS Dataset and study design CHS is the largest health maintenance organization (HMO) in Israel and one of the largest HMO’s globally, serving a popula- tion of over 4,400,000 patients. Dermatology consultations at CHS can take place in 3 different settings; an inpatient setting (hospitalization), an outpatient setting (in a clinic affiliated with a hospital), or in a primary care clinic (with no hospital affiliation, also called a community setting) where the consultation is perfor- med by an independent board-certified specialist. Consultations with a family physician or primary care paediatrician are free of charge. Community-based dermatology consultations are acces- sible without the need for referral; these involve a small quarterly This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.