PRAGUE – More than half of patients who undergo surgical treatment for hidradenitis suppurativa experience one or more indicators of unmet treatment needs – in other words, a suboptimal result – during the subsequent 12 months, according to Dr. Gregor B. Jemec of the University of Copenhagen.
"Very often hidradenitis suppurativa is considered a disease that is treatable only surgically. This study highlights the need for development of effective nonsurgical treatment options for people with hidradenitis suppurativa," he said at the annual congress of the European Academy of Dermatology and Venereology.
Gregor B. Jemec
Several medical therapies for hidradenitis suppurativa (HS) are backed by reasonably good evidence, but all of them are off label. No approved therapy exists for this chronic, recurrent, scarring, inflammatory skin disease that affects 1%-4% of U.S. adults.
Dr. Jemec presented a retrospective claims-based analysis of the economic burden of failed HS surgery in the United States.
He and his coinvestigators identified 2,668 patients in the Ingenix Employer Solutions database who underwent surgery for HS within 6 months after being diagnosed with the skin disease. The researchers came up with a list of indicators of unmet needs following surgery: development of surgical complications such as scarring, abscess, fistulization, or septicemia; an inpatient stay, office visit, or emergency department visit for HS; or another HS skin surgery. The investigators asked two questions: How many patients experienced one or more of these adverse outcome indicators within 12 months following surgery, and what was the associated economic cost?
Fifty-one percent of patients experienced one or more of the indicators of unmet needs. Fifty-seven percent of this cohort underwent one or more subsequent skin surgeries, mostly excisions. Twenty-three percent of patients in the unmet needs cohort developed abscesses, 15% had septicemia, 5% had an HS hospitalization, and 4% had an emergency department visit for HS.
Patients with unmet needs following HS surgery were significantly older by a mean of 3 years. They also had more comorbid conditions as reflected in their significantly higher mean Charlson Comorbidity Index score. After adjustment for these and other potential confounding variables in a multivariate analysis, the group with indicators of unmet needs had a 63% greater incidence of hospital admission for HS during follow-up than did those without. They also had a 59% greater rate of emergency department visits for HS and a 35% increase in office visits for the skin disease.
Total health care costs during the 12 months following HS surgery averaged $13,235 for patients with indicators of unmet needs, compared with $8,193 for those who were trouble free after surgery. After multivariate adjustment, costs in the unmet needs group were an average of $3,109 higher, with the bulk of this difference being driven by the increased rate of inpatient stays for HS.
This study was funded by Abbott Laboratories, which is developing its tumor necrosis factor inhibitor adalimumab (Humira) as a therapy for HS. Abbott has two pivotal 36-week, randomized, double-blind, placebo-controlled, multinational phase III clinical trials underway. Dr. Jemec is a consultant to the company and has received research grants from and/or serves as a consultant to multiple other pharmaceutical companies.