Skip to main content
Log in

Medication Adherence, Healthcare Costs and Utilization Associated with Acne Drugs in Medicaid Enrollees with Acne Vulgaris

American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background

Acne vulgaris is a common chronic disease that may require long-term treatment. Medication adherence is critical to acne management; non-adherence is a common reason for treatment failure and can lead to poor quality of life.

Objective

The aim of the study was to examine medication adherence, healthcare costs, and utilization associated with acne drugs among acne patients in the USA.

Methods

This was a retrospective cohort study from January 2004 to December 2007 using the Marketscan Medicaid Database, a national healthcare claims database. The study followed acne patients aged 0–64 years for 90 days after the first acne drug prescription to measure acne medication adherence, acne-related outpatient visits, and total acne-related healthcare costs. Adherence was measured among different acne drug classes using medication possession ratio (MPR). Multivariate regression analyses were conducted to assess the outcomes.

Results

The study included 24,438 eligible patients, of whom 89.39 % were under 18 years old. The average adherence rate to acne drugs (MPR) was 0.34, and only 11.74 % of the patients were adherent (MPR ≥0.80). Patients with drug refills had a higher adherence rate (MPR = 0.74) than who those without refills (MPR = 0.27). Factors significantly associated with adherence were age, comorbidity, gender, number of drug refills and number of drug classes used. Patients were more adherent to oral retinoids than any other acne drug classes (MPR = 0.78, 57 % adherent). Patients were less adherent to oral antibiotics (MPR = 0.21) and topical retinoids (MPR = 0.31). After controlling for medication use behavior, the use of oral antibiotics decreased the number of acne-related outpatient visits by 50.9 % (p < 0.001) and lowered acne-related total costs by 51.7 % (p < 0.001).

Conclusion

Medication non-adherence is generally prevalent among young acne patients enrolled in Medicaid. The combination of a topical retinoid and an antibiotic agent may be a good choice given their associated healthcare outcomes and costs. However, adherence to these agents is not satisfactory. Therefore, developing specific strategies to improve adherence to these drugs among teenage acne patients is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Del Rosso JQ. Combination topical therapy in the treatment of acne. Cutis. 2006;2(Suppl. 1):5–12.

    Google Scholar 

  2. Lasen RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol. 1998;134:454–8.

    Article  Google Scholar 

  3. Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. 2011;131(2):363–70.

    Article  PubMed  CAS  Google Scholar 

  4. Kubota Y, Shirahige Y, Nakai K, et al. Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents. J Dermatol. 2010;37(7):617–22.

    Article  PubMed  Google Scholar 

  5. Mallon E, Newton JN, Klassen A, et al. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol. 1999;140(4):672–6.

    Article  PubMed  CAS  Google Scholar 

  6. Bickers DR, Lim HW, Margolis D, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006;55:490–500.

    Article  PubMed  Google Scholar 

  7. Patel P, Lin HC, Feldman SR, et al. Medication choice and associated health care outcomes and costs for patients with acne and acne-related conditions in the United States. J Drugs Dermatol. 2011;10(7):766–71.

    PubMed  Google Scholar 

  8. Gollnick HP, Finlay AY, Shear N. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol. 2008;9:279–84.

    Article  PubMed  Google Scholar 

  9. Dreno B, Thiboutot D, Gollnick H, et al. Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol. 2010;49:448–56.

    Article  PubMed  Google Scholar 

  10. Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56:651–63.

    Article  PubMed  Google Scholar 

  11. Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003;49:S1–37.

    Article  PubMed  Google Scholar 

  12. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value in Health. 2008;11(1):44–7.

    Article  PubMed  Google Scholar 

  13. Zaghloul SS, Cunliffe WJ, Goodfield MJ. Objective assessment of compliance with treatments in acne. Br J Dermatol. 2005;152:1015–21.

    Article  PubMed  CAS  Google Scholar 

  14. Balkrishnan R, Kulkarni AS, Cayce K, et al. Predictors of healthcare outcomes and costs related to medication use in patients with acne in the United States. Cutis. 2006;77:251–5.

    PubMed  Google Scholar 

  15. Lott R, Taylor SL, O’Neill JL, et al. Medication adherence among acne patients: a review. J Cosmet Dermatol. 2010;9:160–6.

    Article  PubMed  Google Scholar 

  16. Joish VN, Boklage S, Lynen R, et al. Use of drospirenone/ethinyl estradiol (DRSP/EE) among women with acne reduces acne treatment related resources. J Med Econ. 2011;14:681–9.

    Article  PubMed  Google Scholar 

  17. McEvoy B, Nydegger R, Williams G. Factors related to patient compliance in the treatment of acne vulgaris. Int J Dermatol. 2003;42:274–80.

    Article  PubMed  Google Scholar 

  18. Cook-Bolden F. Subject preferences for acne treatments containing adapalene gel 0.1%: results of the MORE trial. Cutis. 2006;78(1 Suppl):26–33.

    PubMed  Google Scholar 

  19. Yentzer BA, Alikhan A, Teuschler H, et al. An exploratory study of adherence to topical benzoyl peroxide in patients with acne vulgaris. J Am Acad Dermatol. 2009;60:879–80.

    Article  PubMed  Google Scholar 

  20. Steiner JK, Koepsell TD, Fihn SD, et al. A general method of compliance assessment using centralized pharmacy records. Description and validation. Med Care. 1988;26:814–23.

    Article  PubMed  CAS  Google Scholar 

  21. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  22. StataCorp. 2011. Stata Statistical Software: Release 12. College Station: StataCorp LP.

  23. Yentzer BA, Irby CE, Fleischer AB Jr, et al. Differences in acne treatment prescribing patterns of pediatricians and dermatologists: an analysis of nationally representative data. Pediatr Dermatol. 2008;25(6):635–9.

    Article  PubMed  Google Scholar 

  24. Balkrishnan R, Bhosle MJ, Camacho F, et al. Prescribing patterns for topical retinoids: analyses of 15 years of data from the National Ambulatory Medical Care Survey. J Dermatolog Treat. 2010;21:193–200.

    Article  PubMed  Google Scholar 

  25. Yentzer BA, Gosnell AL, Clark AR, et al. A randomized controlled pilot study of strategies to increase adherence in teenagers with acne vulgaris. J Am Acad Dermatol. 2011;64(4):793–5.

    Article  PubMed  Google Scholar 

  26. Johson RL, Roter D, Powe NR, et al. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.

    Article  Google Scholar 

  27. Schoenthaler A, Allegrante JP, Chaplin W, et al. The effect of patient-provider communication on medication adherence in hypertensive black patients: does race concordance matter? Ann Behav Med 2012;43(3):372–82. doi:10.1007/s12160-011-9342-5.

    Google Scholar 

  28. Miyachi Y, Hayashi N, Furukawa F, et al. Acne management in Japan: study of patient adherence. Dermatology. 2011;223:174–81.

    Article  PubMed  Google Scholar 

  29. Baldwin HE. Tricks for improving compliance with acne therapy. Dermatol Ther. 2006;19:224–36.

    Article  PubMed  Google Scholar 

  30. Tan X, Feldman SR, Chang J, et al. Topical drug delivery systems in dermatology: a review of patient adherence issues. Expert Opin Drug Delivery. 2012;9(10):1263–71.

    Article  CAS  Google Scholar 

  31. Yentzer BA, Ade RA, Fountain JM, et al. Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial. Cutis. 2010;86(2):103–8.

    PubMed  Google Scholar 

  32. Boker A, Feetham HJ, Armstrong A, et al. Do automated text messages increase adherence to acne therapy? Results of a randomized, controlled trial. J Am Acad Dermatol. 2012;67:1136–42.

    Article  PubMed  Google Scholar 

  33. Yentzer BA, Wood AA, Sagransky MJ, et al. An internet-based survey and improvement of acne treatment outcomes. Arch Dermatol. 2011;147(10):1223–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex.

The relevant abstract has been submitted to the International Investigative Dermatology 2013 meeting for review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xi Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, X., Al-Dabagh, A., Davis, S.A. et al. Medication Adherence, Healthcare Costs and Utilization Associated with Acne Drugs in Medicaid Enrollees with Acne Vulgaris. Am J Clin Dermatol 14, 243–251 (2013). https://doi.org/10.1007/s40257-013-0016-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-013-0016-x

Keywords

Navigation