Special report: The growing burden of skin disease

Marta Van Beek, MD, MPH: “The big take-home is that the average number of skin diseases in any patient across the general population is 1.6. That means that often one person does not have just one skin diagnosis.”

The total cost of skin disease was $75 billion in the United States in 2013, an average of $887 per patient. While that was a heavy financial load, skin disease has had an even greater impact in a variety of ways that are outlined in a new AAD report, “The Burden of Skin Disease in the United States.”

The report is being published in three parts in the Journal of the American Academy of Dermatology, and it was summarized by Marta Van Beek, MD, MPH, Friday during a Plenary lecture, “The Burden of Skin Disease: Implications for Our Specialty.” She is a member of the AAD’s Burden of Skin Disease Work Group.

Studies and work group augment evaluation

The work group was tasked with updating information from the original study on the burden of skin disease, which was released in 2004. To evaluate cost, the work group studied 2013 medical claims reports because it was the most recent data available.

“Since 2004, there have many changes to the health care landscape, including the establishment of the Affordable Care Act, electronic health records, and major breakthroughs in medications for some of our chronic and common skin diseases, like psoriasis and atopic dermatitis. We thought we needed to re-evaluate where we are now,” Dr. Van Beek said in an interview about her lecture.

The study launched with a list of 24 common skin disease diagnoses treated by dermatologists and non-dermatologists. The greatest prevalence of disease was in the categories of non-cancerous skin growths, cutaneous infections, viral and fungal diseases, wounds and burns, contact dermatitis, and actinic damage. Prevalence was lowest for bullous diseases, cutaneous lymphoma, and vitiligo.

“The big take-home is that the average number of skin diseases in any patient across the general population is 1.6. That means that often one person does not have just one skin diagnosis. If somebody comes in for psoriasis, they often have other concerns,” said Dr. Van Beek, clinical professor of dermatology at Carver College of Medicine and chief of staff at the University of Iowa Hospitals & Clinics.

Age increases risk

In 2013, 85 million Americans — 27 percent of the population — were treated for a skin disease. Data also show that 20-24 percent of patients under the age of 64 have skin disease, and that percentage doubles to 48 percent for patients 65 and older.

“As patients age, the occurrence of non-melanoma skin cancer dramatically increases because of a lifetime of sunlight exposure,” Dr. Van Beek said. “Also, the risk of melanoma increases with age, and that accounts for a considerable cost and burden for skin disease.”

Across the entire population, the most expensive diseases to treat include cutaneous infections, chronic wound and burns, and non-cancerous growths.

“Non-melanoma skin cancer has a relatively low cost of treatment at the individual level, but when you extrapolate it across everyone who gets it, it gets to be quite expensive cumulatively,” Dr. Van Beek said. “In contrast, rare diseases, like cutaneous lymphoma, may be very expensive to treat, but they are rare, so across the general population, it may not appear as costly.”

With the data in hand, the Academy will now try to determine how the specialty can ensure that patients receive the best treatment available at the lowest cost — for patients and providers.

Efficiencies in care

“We are planning to use the data to demonstrate the need to make sure that skin diseases are considered serious medical illnesses with profound health consequences, that costs remain covered by insurance companies, and to demonstrate that there remains a tremendous need for continued investments in skin disease research,” Dr. Van Beek said. “It is important for the specialty to look at the most commonly prescribed drugs and common diagnoses as an aggregate to see where there may be opportunities for efficiencies and improvement in care.”

Some of those efficiencies may come through developing new care delivery models for dermatology.

“Something we have to think about is the way we deliver care to make it more accessible to the general population,” Dr. Van Beek said. “Maybe it is delivering care in teams, maybe it is doing more telemedicine to decrease the burden on the clinics to accommodate more patients. I don’t think we know what the right answer is now, but we need to consider all of the options.”

To shape a better future, the Academy must use its findings to gain support from the public, patients, legislators, and regulators to not only manage skin diseases but learn how to prevent or cure them, she said.

“Information from the Burden of Skin Disease project will inform the efforts of the Academy to advocate for our dermatology members by ensuring that we have the tools and resources to provide the best care for the patients we serve every day,” Dr. Van Beek said.

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