PORTLAND, ORE. (FRONTLINE MEDICAL NEWS) – Dermatologists have plenty of room to improve when it comes to choosing cost-effective medications for acne or rosacea, based on the results of a large retrospective analysis of Medicare claims data.

Patients with acne or rosacea consistently paid more for topical retinoids, topical antibiotics, and oral tetracyclines when the prescriber was a dermatologist instead of a family or internal medicine physician, Myron Zhang reported at the annual meeting of the Society for Investigative Dermatology.

The difference amounted to $3-$4 million per year in the Medicare population alone, which comprises just 5%-6% of all recipients of prescriptions for acne and rosacea, he added.

“There is a large potential for reducing expenditures on health care for patients with acne and rosacea by choosing more generics and less expensive options within drug classes,” said Mr. Zhang, a medical student at the Ohio State University, Columbus, who conducted the study with colleagues there and at Northwestern University in Chicago.

Treating acne and rosacea falls under the purview of both primary and specialty outpatient care, but, researchers had not broken down costs of prescriptions for these conditions by provider type. To help fill that gap, Mr. Zhang and his colleagues retrospectively analyzed all Medicare drug claims for topical retinoids, topical antibiotics, isotretinoin, and oral tetracycline-class antibiotics used to treat acne and rosacea in the United States in 2008 and 2010.

Medicare claims for these prescriptions added up to $65 million in 2008 and $74 million in 2004, Mr. Zhang said. Although most generics either dropped in cost or rose by small amounts in that 2-year span, many brand name prescriptions rose by between 30% and 70%. “Specialist prescriptions were associated with higher brand name usage, a greater variety of medications, and higher costs,” Mr. Zhang said.

Patients paid an average of about $2-$3 more for a topical retinoid, $3-$4 more for oral tetracycline, and $1 more for a topical antibiotic prescribed by a specialist instead of a primary care physician.

This finding might indicate that dermatologists are more comfortable prescribing a greater variety of medications for acne and rosacea, such as tazarotene, azelaic acid, and sulfacetamide, while primary care physicians might stick to a narrower range of medicines, Mr. Zhang said. However, the prescribing behavior of dermatologists could also reflect “external factors,” such as increased contact with representatives from pharmaceutical companies, he added.

“As always, prescription costs need to be weighed against patient preference, compliance, and quality of care,” he said. “More outcomes research is needed to understand the comparative efficacy of generic and brand name treatments.”

The study included both rosacea and acne so that the researchers could capture the total costs of medications such as tretinoin, which is used to treat both conditions. Approximately 80% of topical retinoid prescriptions were for tretinoin, about 50% of topical antibiotic prescriptions were for metronidazole, while about 27% were for clindamycin. About half of oral antibiotic prescriptions were for tetracycline, while about 40% were for minocycline.

Mr. Zhang reported having no conflicts of interest.



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