Prescription refills and healthcare costs associated with topical metronidazole in Medicaid enrolled patients with rosacea

Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty

BACKGROUND

Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking.

OBJECTIVE

To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties.

METHODS

A cross-sectional study was performed of the 2008 and 2010 Centers for Medicare and Medicaid Services Prescription Drug Profiles, which contains 100% of Medicare part D claims.

RESULTS

Topical antibiotics accounted for 63% of all prescriptions. Patients ≥65 years utilized more oral tetracycline-class antibiotics and less topical retinoids. Specialists prescribed brand name drugs for the most common topical retinoids and most common topical antibiotics more frequently than family medicine/internal medicine (FM/IM) physicians by 6%-7%. Topical retinoids prescribed by specialists were, on average, $18-$20 more in total cost and $2-$3 more in patient cost than the same types of prescriptions from FM/IM physicians per 30-day supply. Specialists (60%) and IM physicians (56%) prescribed over twice the rate of branded doxycycline than FM doctors did (27%). The total and patient costs for tetracycline-class antibiotics were higher from specialists ($18 and $4 more, respectively) and IM physicians ($3 and $1 more, respectively) than they were from FM physicians.

LIMITATIONS

The data might contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms might underestimate the number of specialist brand name prescriptions.

CONCLUSION

Costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options.

Patterns of ambulatory care usage and leading treatments for rosacea

BACKGROUND

Millions of rosacea sufferers are not being treated, and the reasons they do not get treatment are not well characterized.

OBJECTIVE

The aim of this study is to determine the main reasons for visit, providers seen and treatments used for rosacea.

METHODS

We used data from the National Ambulatory Medical Care Survey for 1993-2010, tabulating the leading reasons for visit, providers seen and treatments used in rosacea visits.

RESULTS

There were 1 750 000 visits per year for rosacea. The leading reasons for visit were other diseases of the skin (25.3%), skin rash (19.6%), and discoloration or abnormal pigmentation (14.7%). Dermatologists managed 72.4% of visits. The most common treatments used were topical metronidazole (29.3%), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%), and oral metronidazole (6.9%).

LIMITATIONS

Some reasons for visit were too nonspecific to provide good insight on why the patient made a visit.

CONCLUSIONS

Dermatologists manage rosacea most commonly, but primary care physicians need the proper training to diagnose it correctly. Improved strategies to reach untreated people with rosacea are needed.

Preventive medication adherence in African American and Caucasian headache patients

STUDY OBJECTIVES

To examine race-related differences in adherence to preventive medication agents in headache patients and identify factors predictive of medication adherence in Caucasian and African American headache patients.

METHODS

Using a longitudinal naturalistic study design, data from 77 Caucasian and 32 African American headache patients were collected through (1) 30-day daily diaries that assessed medication adherence, headache frequency, and headache episode severity; (2) self-administered surveys that assessed headache management self-efficacy; and (3) telephone-administered psychiatric interviews that yielded psychiatric diagnoses. Using daily diary adherence data, patients' adherence to preventive agents was dichotomized as "Inconsistent" (ie, adhered fewer than 80% of days) or "Consistent" (ie, adhered ≥ 80% of days during the past month).

RESULTS

The proportion of adherent African American patients (69%) did not differ significantly from the proportion of adherent Caucasian patients (82%). Exploratory univariate logistic regression analyses found that preventive medication adherence levels of 80% or less were associated with being diagnosed with major depressive disorder and lower levels of headache management self-efficacy.

CONCLUSIONS

Future research should test if interventions that reduce depressive symptoms and increase patients' levels of headache management self-efficacy can produce concomitant increases in adherence to preventive headache agents.

[Rosacea 2009 : new advances in pathophysiology, clinical staging and therapeutic strategies]

Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple therapeutic options.