Understanding Flares in Patients With Generalized Pustular Psoriasis Documented in US Electronic Health Records.

Importance: Other than single-center case studies, little is known about generalized pustular psoriasis (GPP) flares. Objective: To assess GPP flares and their treatment, as well as differences between patients with and patients without flares documented in US electronic health records (EHRs). Design, Setting, and Participants: This retrospective cohort study included adult patients with GPP (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L40.1) identified in Optum deidentified EHR data between July 1, 2015, and June 30, 2020. The index GPP diagnosis was the first occurrence in the EHR, with no coded history of GPP for at least 6 months prior. Flare episodes were identified using an algorithm based on diagnosis coding, care setting, type of clinician, GPP disease terms, and flare terms and attributes in the EHR. Main Outcomes and Measures: Flare episodes were characterized by the frequency of occurrence per patient, the care setting in which they were identified, the type of specialist managing the episode, associated symptoms, and the type of treatment before, during, and after the episode. Patients were divided into groups based on whether or not they had a flare episode documented in their EHR. Comparisons were made between the groups based on demographic characteristics, comorbidity burden, health care use, and treatments. Results: Of 1535 patients with GPP (1018 women [66.3%]; mean [SD] age, 53.4 [14.7] years), 271 had 513 flares documented. Compared with patients without flares, patients with flares had a 34% higher mean (SD) Charlson Comorbidity Index score (2.80 [3.11] vs 2.09 [2.52]), were almost 3 times more likely to have inpatient visits (119 of 271 [44%] vs 194 of 1264 [15%]), were more than twice as likely to have emergency department (ED) visits (126 of 271 [47%] vs 299 of 1264 [24%]), and had higher use of almost all treatment classes. Flares were identified in outpatient (271 of 513 [53%]), inpatient (186 of 513 [36%]), and ED (48 of 513 [9%]) settings. The most common treatments during flares were topical corticosteroids (35% of episodes [178 of 513]), opioids (21% [106 of 513]), other oral treatments, (eg, methotrexate, cyclosporine, tacrolimus; 13% [67 of 513]), and oral corticosteroids (11% [54 of 513]). Almost one-fourth of flare episodes (24% [122 of 513]) had no dermatologic treatment 30 days before, during, or 30 days after a flare episode. Conclusions and Relevance: This cohort study suggests that there is significant unmet need for the treatment of GPP and its flares, as evidenced by patients seeking treatment in inpatient and ED settings, as well as the lack of advanced treatments.

Comparison of Healthcare Costs Associated With Patients Receiving Traditional Negative Pressure Wound Therapies in the Post-Acute Setting.

Objective A retrospective national insurance claims database analysis evaluated total and wound-related costs for acute and chronic wound patients treated with negative pressure wound therapy (NPWT), comparing a product specific NPWT (NPWT-K) to other NPWT systems (NPWT-O). Methods Patients with one or more NPWT claims between January 2016 and September 2018 in an outpatient setting with continuous medical and pharmacy benefits for six months before the initial (index) NPWT claims and 12 months post index were assessed. The cohorts were propensity score matched based on age, gender, comorbidities, and payer type. Each cohort included 3,368 patients after matching. Costs were evaluated at 30 days, three months, and 12 months after initial NPWT placement. Hospital admission rates, emergency room (ER) visits, and NPWT device switching were evaluated at 30 days. Differences were analyzed by t-test and chi-square test. Results At 30 days, wound-related costs were $8,583 and $11,334, and total cost to treat was $17,809 and $24,405 for NPWT-K and NPWT-O, respectively (p < 0.0001). NPWT-O patients had higher NPWT, wound-related, and total costs across all time periods, as well as a longer average length of therapy (p = .0039). There was no statistical difference in 30-day hospital admissions (p = 0.089); although 30-day ER visits were higher for NPWT-K (4.9% vs. 3.3%, p = 0.0007). A higher degree of switching from NPWT-O to NPWT-K occurred at 30 days (NPWT-O 2.5% vs. 0.4%, p < 0.0001). Conclusions This comparative effectiveness analysis indicates differences remain across NPWT suppliers in wound-related and total cost to treat for patients who receive durable NPWT in the outpatient setting.

Comparison of health care costs and hospital readmission rates associated with negative pressure wound therapies.

OBJECTIVE: A retrospective national claims database analysis evaluated total and wound-related costs (eg, hospital readmission rates) for patients with chronic wounds treated with negative pressure wound therapy (NPWT), comparing NPWT-V (V.A.C. Therapy, KCI, an Acelity company, San Antonio, TX) and NPWT-O (other non-KCI models of NPWT, the brands of which were not known to the researchers). METHODS: Patients with ≥ 1 NPWT claim from January 2009-June 2012 in outpatient settings in the United States were included, if they had continuous medical and pharmacy benefits for 12 months before the initial index date of their NPWT claim and at least 3 months post index. Mean total health care costs were assessed at 3 months and 12 months; wound-related hospital readmission rates were assessed at 3 months and 6 months. Cost differences between cohorts were analyzed by t test and readmission rates were analyzed by chi-square test. RESULTS: At 3 months, the cohort of NPWT-V patients was significantly younger (59.2 vs 63.6 years, P < 0.01). The same patients were followed at 3, 6, and 12 months, although some fell out as time progressed. At the 3-month assessment, mean comorbidity scores did not differ between the NPWT-V group and the NPWT-O groups (3.38 vs 3.66). Total costs were lower for NPWT-V vs NPWT-O at 3 months ($35,498 vs $39,722, respectively; P = 0.08) and 12 months ($80,768 vs $111,212; P = 0.03). Significantly lower inpatient (P = 0.01), emergency room (P < 0.01), and home (P = 0.05) costs, despite higher (P = 0.04) NPWT costs, accounted for lower 12-month NPWT-V total costs. Wound-related readmission rates were significantly lower for NPWT-V at 3 months (5% vs 8%; P ≤ 0.01) and 6 months (6% vs 11%; P ≤ 0.01). For all wound types, NPWT-O patients had a 17-fold higher rate of switching to alternate NPWT models compared with NPWT-V patients. CONCLUSION: In this retrospective analysis, NPWT-V patients had lower total costs, lower wound-related costs, and lower hospital readmission rates than NPWT-O patients at all time points assessed.