Treatment Switching Associated With Increased Health Care Utilization and Costs Among Patients With AD
Key Takeaways:
- In a study analyzing patients with moderate to severe atopic dermatitis (AD), 5.8% switched to second-line treatments.
- Treatment switchers had higher rates of health care utilization compared to non-switchers, with an estimated annual increase of 9 all-cause and 3 AD-related outpatient service visits.
- Switchers had higher care costs compared to non-switchers, primarily due to increased utilization and higher drug costs.
While the approval of systemic targeted therapies has expanded the treatment landscape for AD, treatment sequencing guidelines remain poorly characterized. Furthermore, few studies have assessed the clinical and economic burden associated with switching to successive lines of therapy.
Study Methods and Outcomes
Using data from the Merative MarketScan Commercial Claims and Encounters (CCAE) databases, researchers conducted a real-world retrospective cohort study of patients with moderate to severe AD who initiated treatment between January 2021 and December 2022, with a follow-up of 1 year.
The study compared health care utilization and care costs between treatment switchers and non-switchers.
Patient Characteristics
The study included 8063 patients with moderate to severe AD, with 7597 (94.2%) non-switchers and 466 (5.8%) switchers.
Dupilumab was the first-line treatment for nearly all study participants (99.4%). For those who switched treatments, second-line therapy options included upadacitinib (56.3%), tralokinumab (35.2%), and abrocitinib (8.5%).
After treatment initiation, switchers were more likely to receive oral corticosteroids and topical corticosteroids compared to non-switchers, 27.7% vs 15.8% and 41.6% vs 25.2%, respectively.
Increased Utilization and Costs Among Treatment Switchers
Rates of all-cause hospitalization were comparable between cohorts, with 5.4% of switchers and 5.2% of non-switchers experiencing at least 1 hospitalization.
Switchers had significantly higher rates of emergency department visits compared to non-switchers, 31.8% vs 22.3%, respectively.
Nearly all study participants had at least 1 all-cause outpatient service. However, the annualized rate of outpatient visits was higher among switchers than non-switchers, 26.9 vs 22.0, respectively. For AD-related outpatient visits, switchers had higher rates compared to non-switchers, 96.4% vs 82.8%, respectively.
Compared to non-switchers, switchers had an estimated annual increase of 9 all-cause and 3 AD-related outpatient service visits.
In addition to increased health care utilization, treatment switchers accumulated higher care costs compared to non-switchers. Switchers had an additional $11 408 in total all-cause costs.
Switchers also had higher total AD-related costs compared to non-switchers, $59 876 vs $51 327, respectively. These costs were mainly driven by higher drug costs among switchers. AD-related medical costs were $630 for switchers and $299 for non-switchers.
Implications for Managed Care
The switch rate among patients with moderate to severe AD was low, suggesting the effectiveness of current first-line treatments at disease management.
Patients who did switch therapies had higher utilization rates and care costs compared to those who did not switch, which may reflect disease severity, inadequate response, or treatment intolerability. Further research on the factors influencing treatment switching may help inform guidelines and decision making.
The authors concluded, “These findings emphasize the increased importance of personalized considerations for the selection of first-line systemic targeted therapy for patients with moderate to severe AD to reduce downstream economic burden.”
Reference
Li KH, Gray SL, Sullivan SD. Health care resource utilization and costs of commercially insured US patients with atopic dermatitis switching from first-line to second-line systemic targeted therapies. J Managed Care Specialty Pharm. 2026;32(1):75-84. doi:10.18553/jmcp.2026.32.1.75
