A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effective

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL.

Methods

EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called ‘acne-inversa-centres (AiZ)’ where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI).

Results

Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective.

Conclusion

Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.

KEY MESSAGE

A structured, multimodal form of care reduces costs in the treatment of Hidradenitis suppurativa compared to standard care.

Keywords:

• Hidradenitis suppurativa
• treatment costs
• innovative care concept
• ambulatory care

View correction statement:

Correction

Acknowledgements

We would like to thank the company LAUER-FISCHER GmbH, who kindly provided us with free access to LAUER-TAXE®. On this basis, pharmaceutical indices from the routine data of the health insurance funds could be assigned to the respective therapy allocations.

We would like to thank Dr Faraz Mahmood Ali MBBCh PhD MRCP(Derm) PGCert(Med Ed) who kindly provided us the mapping algorithm ‘DLQI to EQ5D Utility Values OLR Model Program’.

Disclosure statement

Michael Schultheis: Grants or contracts from any entity: LENICURA GmbH – auditor activity on the implementation of the contract ‘AOK-Priomed Acne inversa’ | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Pfizer AbbVie – honoraria for lectures | Support for attending meetings and/or travel: AbbVie, Pfizer, Almirall – funding of travel, congress, and hotel fees

Petra Staubach: Grants or contracts from any entity: Novartis; Allmirall | Consulting fees: AbbVie, Allergika, Almirall-Hermal, Amgen, Beiersdorf, Biocryst, BMS, Boehringer-Ingelheim, Celgene, CSL-Behring, Eli-Lilly, Falk, Galderma, Hexal, Janssen, Klinge, Klosterfrau, LEO-Pharma, LETI-Pharma, L’Oreal, Novartis, Octapharma, Pfizer, Pflüger, Pharming, Regeneron, Shire, Takeda, Sanofi-Genzyme, UCB Pharma | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid unrelated to current work presented here: Society of dermopharmazie

Georgios Nikolakis: Consulting fees – Dessau Medical Center received a consulting fee from Mölnlycke Health Care GmbH, for which I served as a consulting physician |Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Speaker for the EADV HS Course 28-30.11.2022, Porto, Portugal | Support for attending meetings and/or travel: Elli Lilly Scholarship for attending EADV 2021 | Participation in a data protection monitoring board or advisory board – Dessau Medical Center received a consulting fee from Mölnlycke Health Care GmbH, for which I served as a consulting physician

Lukas Schollenberger: None

Melanie Mauch: None

Marion Burckhardt: None

Marcus Heise: None

Marina Zamsheva: None

Alexandra Strobel: None

Gero Langer: None

Falk Bechara: Consulting fees: AbbVie Int., Incyte Corporation, AbbVie Deutschland GmbH und Co., MoonLake, Novartis Pharma GmbH, Janssen Cilag GmbH, UCB Pharma | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational event:

AbbVie Int., Incyte Corporation, AbbVie Deutschland Gmbh und Co, Novartis Pharma GmbH, Janssen Cilag GmbH, UCB Pharma | Support for attending meetings and/or travel: AbbVie Int., Incyte Corporation, AbbVie Deutschland GmbH und Co., Novartis Pharma GmbH, Janssen Cilag GmbH, UCB Pharma | Participation on a data protection monitoring board or advisory board: AbbVie Int., Incyte Corporation, AbbVie Deutschland Gmbh und Co, Novartis Pharma GmbH, Janssen Cilag GmbH, UCB Pharma, Boehringer Ingelheim Pharma

Uwe Kirschner: Consulting Fees: Novartis | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Novartis | Participation on a data protection monitoring board or advisory board: Novartis, EsmAiL, EpiCAi | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Deutsche Gesellschaft für Wundheilung und Wundbehandlung

Katharina Hennig: Patents planned, issued or pending: DE102015000150B4 | Stocks or stock options LENICURA GmbH – CEO and stockholder of the company

Christian Kunte: None

Matthias Goebeler: Grants or contracts from any entity: Clinical studies on Hidradenitis suppurativa; my role: Deputy-PI; sponsors: Novartis, Janssen, UCB; clinical studies on pemphigus vulgaris and bullous pemphigoid; my role: PI; sponsor: Argenx; clinical study on Prurigo nodularis; my role: PI; Sponsor: Galderma – contract with my institution; no personal payment; consulting fees: Allmirall – personal payment; Argenx – payment to institution | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: GSK, Lilly, JANSSEN – personal payment | Support for attending meetings and/or travel: UCB – travel support | Participation in a data protection monitoring board or advisory board: UCB, GSK, LEO – personal payment | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid unrelated to current work presented here: Member of the Board of Directors and Treasurer of the German Society of Dermatology (‘Deutsche Dermatologische Gesellschaft’), Section Editor ‘Journal der Dt. Dermatologischen Gesellschaft’, Member of the Board of Directors of the University Hospital Würzburg – all unpaid

Maurizio Podda: Maurizio Podda: Consulting fees: AbbVie, CSL, Galderma, Novartis, Janssen Cilag, UCB | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: AbbVie, Beiersdorf, BMS, Eli Lilly, Galderma, Janssen Cilag, Leo Pharma, L’Oreal, Novartis, MSD, UCB | Support for attending meetings and/or travel: AbbVie, Beiersdorf, BMS, Eli Lilly, Galderma, Janssen-Cilag, Leo Pharma, L’Oreal, Novartis, MSD, UCB | Participation on a Data Safety Monitoring Board or Advisory Board: AbbVie, Boehringer Ingelheim, CSL, Galderma, Janssen-Cilag, MoonLake, Novartis, L’Oreal, UCB | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: HiSNet Rhein Main e.V., President.

Stephan Grabbe: Grants or contracts from any entity: Novartis, Pierre Fabre | Consulting fees: AbbVie, BMS, MSD, Genzyme, Klinge Pharma, Sun Pharma, Kyowa-Kirin, Novartis, Pierre Fabre | Participation on a Data Safety Monitoring Board or Advisory Board: Alcedis | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid unrelated to current work presented here: DeCOG, German dermatological cooperative oncology group – unrelated to current work presented here.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/09546634.2024.2302710)

Additional information

Funding

Innovation section, Germany; Institutional grant to perform the clinical study. The project on which this publication is based was funded by the Innovation Committee of the Federal Joint Committee (Gemeinsamer Bundesausschuss), under the grant number 01NVF18008.