Q&A: Employing cost-effective skin care to benefit patients

Kevin Kia, MD, is the co-director of today’s session “Best Evidence-based Opportunities for Cost-effective Skin Care” (S003). He talked with Dermatology World Meeting News to share a few small practice changes in prescribing and practice patterns that can have a major impact on patient cost while maintaining or even improving clinical outcomes.

How can dermatologists provide more cost-effective skin care?
Dr. Kia: One important area is laboratory tests and the frequency with which we order them compared to the clinical necessity. We will have presentations on prescription rebate programs, the false way rebate cards make you think you are [being] helpful, and ways we can prescribe more appropriately now that topical steroid pricing has changed so dramatically. Providing cost-effective medicine is about spending less and getting more.

What common tests might be  overused?
One of our speakers will be addressing acne and isotretinoin. Historically, we have ordered monthly lab tests, but there is good data suggesting that dermatologists don’t need to monitor as frequently as we routinely do.

For common conditions like urticaria, there is a huge number of tests that could be ordered but there is little data to support the practice. When a patient comes in with onychomycosis, how much of a workup do you really need before and during treatment? We will be arguing that for many common conditions, we should keep our workup to an absolute minimum, using one or two lab tests at most. For the vast number of patients, additional tests have no impact on clinical decision-making or outcomes.

Many dermatologists routinely prescribe generic topical steroids. Is there a problem with that practice?
The three topical steroids that most dermatologists grew up on are desonide, clobetasol, and triamcinolone. They used to be cheap, but generic prices have gone crazy in the last few years. Desonide and clobetasol, in particular, have gotten very expensive. Just two changes — triamcinolone 0.025 instead of desonide, and betamethasone instead of clobetasol — can generate huge cost savings that we write 10 to 30 times every day.

What about prescription rebate cards?
Some clinicians prescribe branded topical steroids thinking they are doing something great for their patients. The reality is that rebate cards just raise the cost to the health care system on the back end. Prescribing the right generic topical steroids creates real savings. Simple changes to things you do routinely in practice add up to huge savings for patients.

Dr. Kia is a clinical assistant professor of dermatology at the University of Texas Southwestern in Dallas.


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