Treatment Patterns, Healthcare Resource Utilization, and Spending Among Medicaid-Enrolled Children with Chronic Idiopathic/Spontaneous Urticaria in the United States

Paul V Williams; Abhishek Kavati; Dominic Pilon; Yongling Xiao; Maryia Zhdanava; Maria-Magdalena Balp; Patrick Lefebvre; Benjamin Ortiz; Vivian Hernandez-Trujillo

doi:10.1007/s13555-018-0225-6

Treatment Patterns, Healthcare Resource Utilization, and Spending Among Medicaid-Enrolled Children with Chronic Idiopathic/Spontaneous Urticaria in the United States

Dermatol Ther (Heidelb). 2018 Mar;8(1):69-83. doi: 10.1007/s13555-018-0225-6. Epub 2018 Feb 10.

Authors

Paul V Williams¹, Abhishek Kavati², Dominic Pilon³, Yongling Xiao⁴, Maryia Zhdanava⁴, Maria-Magdalena Balp⁵, Patrick Lefebvre⁴, Benjamin Ortiz², Vivian Hernandez-Trujillo⁶

Affiliations

¹ Northwest Asthma and Allergy Center, Everett, WA, USA.
² Novartis Pharmaceuticals Corporation, East Hanover, NY, USA.
³ Analysis Group, Inc, Montréal, QC, Canada. dominic.pilon@analysisgroup.com.
⁴ Analysis Group, Inc, Montréal, QC, Canada.
⁵ Novartis Pharma AG, Basel, Switzerland.
⁶ Herbert Wertheim School of Medicine, Florida International University, Miami, FL, USA.

Abstract

Introduction: Few studies have described chronic idiopathic/spontaneous urticaria (CIU/CSU) healthcare burden in adults, while this information remains largely unknown in children. We aimed to describe treatment patterns, healthcare resource utilization (HRU), and costs in CIU/CSU pediatric patients, as well as to compare HRU and costs in CIU/CSU and CIU/CSU-free pediatric patients.

Methods: Medicaid claims from four states (09/01/2013-03/31/2016) were used to identify patients less than 12 years old. The CIU/CSU cohort included patients with either at least two claims for idiopathic, other, or unspecified urticaria at least 6 weeks apart, or at least one claim for urticaria and at least one claim for angioedema at least 6 weeks apart (index date defined as the first claim). The control cohort included patients without urticaria/angioedema claims (index date randomly assigned). Patients without at least 6 months of continuous Medicaid eligibility pre- and post-index were excluded. HRU and costs were compared between propensity score-matched cohorts during the post-index follow-up.

Results: A total of 548 CIU/CSU patients (mean [SD] age 4.5 [3.3] years; 51.3% male) were matched 1:1 with controls. In the CIU/CSU cohort, 51.8% used non-sedating prescription H₁-antihistamines, 24.3% used oral corticosteroids, and 23.5% used other prescription H₁-antihistamines; 13.5% consulted allergist/immunologists and 2.4% consulted dermatologists in the first 6 months of follow-up. Compared to controls, CIU/CSU patients had significantly more per patient per year (PPPY) inpatient (incidence rate ratio [IRR] 2.05), outpatient (IRR 2.20), and emergency department (IRR 1.64) visits (all p values < 0.05). Moreover, CIU/CSU patients also had significantly higher PPPY healthcare costs (mean cost difference [MCD] $1853), driven by incremental outpatient (MCD $1286) costs (all p values < 0.01).

Conclusions: CIU/CSU pediatric patients had low use of non-sedating H₁-antihistamines and high use of oral corticosteroids. Compared to CIU/CSU-free controls in the same age group, CIU/CSU pediatric patients had higher HRU and healthcare costs.

Funding: Novartis Pharmaceuticals Corporation.

Keywords: Children; Chronic idiopathic urticaria; Chronic spontaneous urticaria; Healthcare burden; Healthcare resource utilization; Medicaid; Pediatric; Treatment patterns.