JEADV Clinical Practice (Sep 2023)
A real‐world retrospective observational study exploring resource use for secondary care management of moderate‐to‐severe atopic dermatitis in children and adolescents at a single site in Ireland
Abstract
Abstract Background Management of paediatric atopic dermatitis (AD) remains challenging, and presents a considerable healthcare resource utilisation (HCRU) burden. Objectives To describe secondary HCRU for children and adolescents with moderate‐to‐severe AD in Ireland. Methods This was a single‐centre chart review of children (age 6–11 years) and adolescents (age 12–17 years) with clinician‐confirmed moderate‐to‐severe AD. Eligible patients were selected consecutively, starting with the most recently consulting patient, and working backwards until patient identification for the study was complete. From first secondary care appointment post 1 January 2014, at least 12 months' medical record data were abstracted, including patient demographics/clinical characteristics, treatments, HCRU, and patient‐reported outcomes. Results Data were abstracted for 31 patients (22 children). Mean (SD) duration of observation was 4.4 (1.9) years. Most patients (74.2%) had severe AD at first referral, a mean (SD) of 2.7 (1.5) comorbid conditions, 2.2 (1.1) patient‐reported flare episodes/patient/year‐of‐observation, and 18.5 (12.2) tests/scans/procedures/patient/year‐of‐observation. Patients had tried a mean (SD) of 7.9 (5.3) treatments/patient/year‐of‐observation. Topical corticosteroids (TCS; 48.5% of prescriptions) were most frequently prescribed. Mean (SD) use (duration) of TCS, nonsteroidal topicals (tacrolimus, 4.1% of prescriptions), systemic corticosteroids (prednisolone, 2.2%), and systemic immunosuppressants (10.7%, of which methotrexate was 68.2%) was 38.6 (41.1), 54.4 (41.1), 2.0 (3.1), and 27.6 (21.1) months. Mean (SD) consultations/patient/year‐of‐observation was 15.3 (6.3); 28 (5.9%) for flare. Eight (25.8%) patients were hospitalised (including six children). There were 0.03 hospitalisations/patient/year‐of‐observation, and 4.4 nights spent in hospital, mostly for flare. Earliest mean (SD) Children's Dermatology Life Quality Index score was 9.7 (6.2); latest was 6.6 (5.5). Conclusion This is the first study examining paediatric AD HCRU in an Irish healthcare setting. Moderate‐to‐severe paediatric AD results in complex treatment, with high healthcare burden in hospital outpatient care. Despite treatment and a low hospitalisation rate, patients experience flare, lengthy hospital stays, and minor changes in quality of life.
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