Study Quantifies, Characterizes Health Care Burden of Prurigo Nodularis in England

A study published in the Journal of Dermatological Treatment recently quantified and characterized health care burden associated with prurigo nodularis (PN) in England.¹

According to researchers, this study represents the first to explore and assess health care resource utilization for PN in England.

Prurigo nodularis on the lower leg | Image Credit: © Te Whatu Ora Health New Zealand

Background and Methods

A 2020 study published in the British Journal of Dermatology reported that among dermatologic patients in the US, individuals with PN incur significantly higher heath care-associated costs than patients with conditions like atopic dermatitis and psoriasis, for example.²

Additionally, patients with PN were found to be 5 times more likely to be treated within the medical specialties of dermatology and internal/family medicine than other patients with dermatologic conditions, placing an additional health care-associated burden on this population.²

Authors of the present study sought to assess the economic impact of PN in England, with a close analysis of cost and its impact on treatment decisions and availability, citing a lack of previous studies of a similar nature.

Researchers selected adult patients from the Clinical Practice Research Datalink and the linked Hospital Episode Statistics utilizing medical codes for PN. The enrollment period spanned April 2007 to March 2019. All patients were required to partake in a 180-day washout period with a minimum follow-up of 1 year.

Findings

The study involved 8,933 patients diagnosed with PN, of which 2,498 (28%) were classified as having moderate to severe PN (MSPN). A cohort of 2,462 patients was matched for the primary analysis, with an additional sensitivity analysis performed on a subset of 1,419 patients.

The study demonstrated substantial differences in health care resource utilization between patients with MSPN and mild PN, highlighting the increased burden of care for those with more severe disease. On average, patients with PN had a primary care visit rate of 14.27 visits per patient year (PPY), at a cost of £359 per year. Patients also visited outpatient departments at a rate of 6.68 PPY, costing £755 per year, with dermatology outpatient visits specifically occurring at 1.76 PPY and costing £165 per year.

However, when comparing the MSPN group to the mild PN group, the disparity became clear. Patients with MSPN visited primary care more frequently, averaging 21.27 PPY, compared to 11.35 PPY in the mild PN group. The corresponding cost for primary care visits nearly doubled, from £274 PPY in the mild PN group to £537 PPY in the MSPN group.

Outpatient visits followed a similar trend, with MSPN patients requiring more frequent visits to any outpatient department (10.72 PPY) compared to mild PN patients (4.87 PPY), costing £1,213 and £563 per year, respectively. Dermatology outpatient visits were also more frequent in the MSPN group (1.96 PPY) versus the mild PN group (1.14 PPY), translating to higher annual costs.

In terms of inpatient admissions, patients with MSPN had a significantly higher rate of hospitalizations (1.75 PPY) compared to those with mild PN (0.66 PPY), with associated costs of £382 and £192 PPY, respectively (p < 0.0001).

The study also emphasized the substantial economic burden posed by PN, particularly in those with MSPN. The costs associated with health care visits and treatments were significantly elevated for this group, impacting both patients and health care systems, with the cost of outpatient dermatology visits for MSPN patients over 60% higher than for mild PN patients and inpatient dermatology admissions costs being more than doubled.

In a subset of patients who had at least 1 recorded outpatient dermatology visit, the frequency of these visits in the MSPN group was 3.52 PPY, costing £324 per year, compared to 2.22 PPY in the mild PN group, which cost £216 per year.

Conclusions

The study may have been limited by non-universal or consistent diagnosis and coding of PN and a lack of inclusion of patients with a history of psychological interventions or psychotropic medication management. However, researchers acknowledged the study's role in better understanding burden of disease associated with PN.

"PN and even more so, [moderate to severe] PN has a high disease burden in England," according to authors Bahloul et al.

Moving forward, researchers noted that the study is indicative of a need more newer, more effective therapies in the PN landscape.

References

1. Bahloul D, Hudson R, Balogh O, et al. Estimating the healthcare burden of prurigo nodularis in England: a CPRD database study. J Dermatolog Treat. 2024;35(1):2367615. doi:10.1080/09546634.2024.2367615
2. Huang AH, Canner JK, Williams KA, Grossberg AL, Kwatra MM, Kwatra SG. Healthcare resource utilization and payer cost analysis of patients with prurigo nodularis. Br J Dermatol. 2020;183(1):182-184. doi:10.1111/bjd.18925