Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims.

INTRODUCTION: Alopecia areata (AA) is an autoimmune disorder causing sudden, non-scarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA. METHODS: Patients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan® Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis. Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data. RESULTS: A total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs. CONCLUSION: Patients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population. Healthcare costs incurred by patients with AA went beyond AA-related expenses. Longitudinal data are needed to better understand treatment trajectories and the disease burden in patients with AA.

Survival Trends of Metastatic Lung Cancer in California by Age at Diagnosis, Gender, Race/Ethnicity, and Histology, 1990-2014.

BACKGROUND: We analyzed the survival trends for patients with metastatic lung cancer in California. MATERIALS AND METHODS: We identified patients first diagnosed with primary lung cancer at distant (metastatic) stage in the California Cancer Registry between 1990 and 2014, with follow-up through end of 2015. Race/ethnicity was categorized into non-Hispanic white, non-Hispanic black, Hispanic, and Asian/Pacific Islander. One-year and 5-year relative survival rates were calculated overall and by age at diagnosis, gender, race/ethnicity, and histology during the study period. Joinpoint regression was used to evaluate the trends and to calculate the annual percentage changes (APCs). RESULTS: A total of 186,156 adults were identified for analysis. Between 1990 and 2014, 1-year relative survival significantly improved from 18.4% to 29.4%, with most improvement observed between 1993 and 2012 (APC, 2.60%; 95% confidence interval, 2.41-2.79; P < .01). Five-year relative survival significantly improved from 2.2% to 5.0%, with an APC of 4.05% (95% confidence interval, 3.47-4.64; P < .01). All age groups experienced an improvement in survival rates. The greatest increases in relative survival were observed among females, Asian/Pacific Islanders, and patients with adenocarcinoma. Yearly survival rates increased for all histologic types over the study period, with adenocarcinoma having the most improvement after 2000. CONCLUSIONS: Survival for patients with metastatic lung cancer in California steadily improved during the 1990 to 2014 period, before the era of lung cancer screening and cancer immunotherapy. The greatest increase in relative survival was observed in those patients who have the most clinical benefit from the history- and biomarker-based precision oncology drugs during the study period.