Conference Coverage

Spending on combination products for acne has increased significantly



– Expenditures for combination acne products increased from $82 million in 1996 to $487 million in 2016, according to an analysis presented at the annual meeting of the American Academy of Dermatology.

During a late-breaking research session, David Li, a fourth-year medical student at Tufts University, Boston, presented the results of a retrospective cost analysis study, conducted to identify trends in overall spending for combination acne products. Spending measures were adjusted for inflation to 2016 U.S. dollars.

While spending on combination products for acne has increased significantly over the past 2 decades, comparative efficacy data for these products are limited, he noted. Combination products are more expensive than the sum of their component parts, and prescribing generic formulations of individual acne treatments could potentially reduce costs, but possible advantages of combination products for acne include improved patient adherence and increased efficacy.

Mr. Li, a research fellow in the department of dermatology at Brigham and Women’s Hospital in Boston, and his colleagues drafted a comprehensive list of available combination products (eight brand-name products and two generics). Most combine benzoyl peroxide with another common acne medication. To analyze trends in medication use, they performed a retrospective cost analysis using Medical Expenditure Panel Survey (MEPS) data from 1996 to 2016, searching for these combination medications to gather the annual number of prescriptions, number of users, expenditures, and aggregate demographics for each product. The data were weighted to represent national estimates.

They also used data from the National Average Drug Acquisition Cost (NADAC) database, used by the Centers for Medicare & Medicaid Services as a pricing benchmark, and calculated the difference between the unit price of each combination product and the sum of the prices of its generic components. They multiplied this difference by the median number of units prescribed annually for the given combination.

The researchers found that most users of combination acne products were younger than 18 years (23%), female (55%), and white (83%), and the most commonly prescribed combination product changed over time. From 1996 to 2002, Benzamycin (benzoyl peroxide and erythromycin) was the most frequently prescribed combination. Several years later, its place was taken by BenzaClin (benzoyl peroxide and clindamycin) from 2003 to 2010, followed by Ziana (clindamycin and tretinoin) in 2011 and Epiduo (adapalene and benzoyl peroxide) from 2012 to 2016.

“Spending has increased steadily from a little bit over $82 million in 1996 to nearly half a billion dollars in 2016,” Mr. Li said. “That’s a rise of more than 500% in the last 20 years. Based on the median pricing and utilization data that we derived from the NADAC database, we determined that substitution with component generics can provide median annual savings of at least a quarter billion dollars each year.”

Although the data indicate a trend toward increased use of and spending on new, branded combination products, the literature includes “minimal data to suggest whether one combination acne product is better than the next one, or how it compares to its component medications when used in combination,” he said. He and his colleagues found no comparative data apart from a 2001 study that examined Benzamycin and BenzaClin, which suggested that there was no difference in efficacy or tolerability between the products.

The present study is limited by reporting bias and recall bias because it relies partly on MEPS, a survey, and the NADAC pricing database had information only for 2013-2016. The researchers consequently used the most recent prices to calculate potential savings.

“Until we have more meaningful data to suggest otherwise, we’re in a state of equipoise,” said Mr. Li.

The research was funded by the National Center for Advancing Translational Sciences, part of the National Institutes of Health.

SOURCE: Li D et al. AAD 2019, Abstract 11333.

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