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von Kobyletzki, L., Henrohn, D., Ballardini, N., Neary, M. P., Ortsäter, G., Rieem Dun, A., . . . Thyssen, J. P. (2023). Comorbidities in childhood atopic dermatitis: a population-based study. Journal of the European Academy of Dermatology and Venereology
Open this publication in new window or tab >>Comorbidities in childhood atopic dermatitis: a population-based study
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2023 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care.

Objective: The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden.

Methods: This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD patients. The risk of developing the following conditions was evaluated: hypersensitivity and allergic disorders, neurological disorders, psychiatric disorders, infections, immunological and inflammatory disorders, Type 1 diabetes (T1D), endocrine and metabolic disorders, skeletal disorders, ocular disorders and malignancies.

Results: This study included 165,145 patients with AD (mild-to-moderate [n = 126,681] and severe [n = 38,464]) and an equally sized reference cohort. Patients with AD displayed a higher risk of developing comorbid conditions for all investigated categories, except for T1D and skeletal disorders, compared with the reference cohort. The highest risk compared with the reference cohort was observed for hypersensitivity and allergic disorders (hazard ratio [HR]: 3.87), followed by malignancies (HR: 2.53) and immunological and inflammatory disorders (HR: 2.36). Patients with AD also had higher risk of developing multiple comorbidities (≥2). The risk of comorbidity onset increased alongside AD severity and patients with active AD were associated with increased risk of comorbidity onset compared with patients in remission.

Conclusions: The clinical burden of AD is substantial for children with AD and patients are at an increased risk of developing several comorbid conditions extending beyond the atopic march. Our results also showed a positive association between worsening severity of AD and an increased risk of comorbidity onset.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-215959 (URN)10.1111/jdv.19569 (DOI)37824103 (PubMedID)2-s2.0-85174597101 (Scopus ID)
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2023-10-30
Hansen, S., von Bülow, A., Sandin, P., Ernstsson, O., Janson, C., Lehtimäki, L., . . . Porsbjerg, C. (2023). Prevalence and management of severe asthma in the Nordic countries: findings from the NORDSTAR cohort. ERJ Open Research, 9(2), Article ID 00687-2022.
Open this publication in new window or tab >>Prevalence and management of severe asthma in the Nordic countries: findings from the NORDSTAR cohort
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2023 (English)In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 2, article id 00687-2022Article in journal (Refereed) Published
Abstract [en]

Background: Real-life evidence on prevalence and management of severe asthma is limited. Nationwide population registries across the Nordic countries provide unique opportunities to describe prevalence and management patterns of severe asthma at population level. In nationwide register data from Sweden, Norway and Finland, we examined the prevalence of severe asthma and the proportion of severe asthma patients being managed in specialist care.

Methods: This is a cross-sectional study based on the Nordic Dataset for Asthma Research (NORDSTAR) research collaboration platform. We identified patients with severe asthma in adults (aged ≥18 years) and in children (aged 6-17 years) in 2018 according to the European Respiratory Society/American Thoracic Society definition. Patients managed in specialist care were those with an asthma-related specialist outpatient contact (only available in Sweden and Finland).

Results: Overall, we identified 598 242 patients with current asthma in Sweden, Norway and Finland in 2018. Among those, the prevalence of severe asthma was 3.5%, 5.4% and 5.2% in adults and 0.4%, 1.0%, and 0.3% in children in Sweden, Norway and Finland, respectively. In Sweden and Finland, 37% and 40% of adult patients with severe asthma and two or more exacerbations, respectively, were managed in specialist care; in children the numbers were 56% and 41%, respectively.

Conclusion: In three Nordic countries, population-based nationwide data demonstrated similar prevalence of severe asthma. In children, severe asthma was a rare condition. Notably, a large proportion of patients with severe asthma were not managed by a respiratory specialist, suggesting the need for increased recognition of severe asthma in primary care.

Place, publisher, year, edition, pages
European Respiratory Society (ERS), 2023
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-207885 (URN)10.1183/23120541.00687-2022 (DOI)000956544900023 ()37020835 (PubMedID)2-s2.0-85153731153 (Scopus ID)
Available from: 2023-05-08 Created: 2023-05-08 Last updated: 2023-05-08Bibliographically approved
von Bülow, A., Hansen, S., Sandin, P., Ernstsson, O., Janson, C., Lehtimäki, L., . . . Porsbjerg, C. (2023). Severe asthma trajectories in adults: findings from the NORDSTAR cohort. European Respiratory Journal, 62(3), Article ID 2202474.
Open this publication in new window or tab >>Severe asthma trajectories in adults: findings from the NORDSTAR cohort
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2023 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 62, no 3, article id 2202474Article in journal (Refereed) Published
Abstract [en]

Background: There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with severe asthma.

Methods: We conducted an observational study based on Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified adult patients with severe asthma in 2018 according to the European Respiratory Society/American Thoracic Society definition and used latent class analysis to identify trajectories of asthma severity over a 10-year retrospective period from 2018.

Results: Among 169 128 asthma patients, we identified 4543 severe asthma patients. We identified four trajectories of severe asthma that were labelled as: trajectory 1 "consistently severe asthma" (n=389 (8.6%)), trajectory 2 "gradual onset severe asthma" (n=942 (20.7%)), trajectory 3 "intermittent severe asthma" (n=1685 (37.1%)) and trajectory 4 "sudden onset severe asthma" (n=1527 (33.6%)). "Consistently severe asthma" had a higher daily inhaled corticosteroid dose and more prevalent osteoporosis compared with the other trajectories. Patients with "gradual onset severe asthma" and "sudden onset severe asthma" developed type 2-related comorbidities concomitantly with development of severe asthma. In the latter group, this primarily occurred within 1-3 years preceding onset of severe asthma.

Conclusions: Four distinct trajectories of severe asthma were identified illustrating different patterns of progression of asthma severity. This may eventually enable the development of better preventive management strategies in severe asthma.

Place, publisher, year, edition, pages
European Respiratory Society, 2023
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-214516 (URN)10.1183/13993003.02474-2022 (DOI)37620041 (PubMedID)2-s2.0-85170581634 (Scopus ID)
Available from: 2023-09-25 Created: 2023-09-25 Last updated: 2023-09-25Bibliographically approved
von Kobyletzki, L., Ballardini, N., Henrohn, D., Neary, M., Ortsäter, G., Geale, K., . . . Thyssen, J. (2022). Care pathways in atopic dermatitis: a retrospective population-based cohort study. Journal of the European Academy of Dermatology and Venereology, 36(9), 1456-1466
Open this publication in new window or tab >>Care pathways in atopic dermatitis: a retrospective population-based cohort study
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2022 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 36, no 9, p. 1456-1466Article in journal (Refereed) Published
Abstract [en]

Background: Atopic dermatitis (AD) is a complex disease with variations in severity and healthcare utilization. Examining patient pathways through analyses of longitudinal patient data provides an opportunity to describe real-world clinical patient care and evaluate healthcare access and treatment.

Objective: To describe longitudinal care pathways including health care management, treatment patterns and disease progression (by proxy measures) in patients with AD.

Materials and methods: This was a longitudinal observational study, which used linked data from national and regional healthcare registers in Sweden. Patients with AD were identified through diagnosis in primary or secondary care or by dispensed medications. Descriptive statistics for number of healthcare visits, type of dispensed drug class, rate of - and time to - referral to secondary care and treatment escalation were calculated.

Results: A total of 341 866 patients with AD distributed as 197 959 paediatric (age < 12), 36 133 adolescent (age ≥ 12- < 18) and 107 774 adult (age ≥ 18) patients were included in this study. Healthcare visits to primary and secondary care and dispensation of AD-indicated treatments were more common during the year in which managed AD care was initiated. Topical corticosteroids (TCSs) and emollients were the most frequently used treatments across all age cohorts while systemic treatment was uncommon in all age cohorts. Among patients who initiated treatment with TCSs, 18.2% escalated to TCSs with higher potency following the start of managed AD care.

Conclusions: We found that healthcare contacts and use of AD-indicated treatments were concentrated in the year during which managed AD care was initiated and decreased significantly thereafter. Since a significant proportion of patients with AD have flares and persistent AD, our results suggest that patients with AD may be monitored infrequently and are undertreated. There is a need to inform practitioners about adequate treatment options to provide individualized care, in particular for patients with persistent severe AD.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-196106 (URN)10.1111/jdv.18185 (DOI)000797055800001 ()35470924 (PubMedID)2-s2.0-85130235662 (Scopus ID)
Available from: 2022-06-17 Created: 2022-06-17 Last updated: 2022-11-16Bibliographically approved
Lindberg, I., Tedeblad, I., Geale, K. & Schubert, A. (2022). Persistence with biologic treatments in psoriasis: A structured literature review of studies using administrative database and clinical registry data. Journal of Drugs in Dermatology, 21(8), 881-889
Open this publication in new window or tab >>Persistence with biologic treatments in psoriasis: A structured literature review of studies using administrative database and clinical registry data
2022 (English)In: Journal of Drugs in Dermatology, ISSN 1545-9616, Vol. 21, no 8, p. 881-889Article, review/survey (Refereed) Published
Abstract [en]

Background: Psoriasis is a chronic, autoimmune-mediated inflammatory disorder. Drug persistence is a composite measure of effectiveness, safety, and treatment satisfaction, often estimated using data from administrative databases and clinical registries. Persistence rates calculated from these two data sources appear to be systematically different.

Objective: Review and compare persistence rates of psoriasis-indicated biologics reported in registry and database studies.

Methods: A structured literature search of studies published during 2009-2019 was performed in PubMed and American Academy of Dermatology records to identify research describing persistence with biologic treatments in psoriasis patients. English language retrospective or prospective persistence studies based on database or registry data, and reporting on at least two psoriasis-indicated biologics, of which at least one was ustekinumab, secukinumab, ixekizumab or guselkumab, were included. Single-arm studies, randomized control trials, systematic literature reviews, and studies presenting stratified results only were excluded.

Results: A total of 37 studies (22 registry- and 15 database-derived) comprising 76,000 patients were included. On average, drug persistence collected from registry studies was 18% higher than database studies.

Conclusion: The findings of this study may be used by practitioners to make meaningful comparisons between persistence data derived from registries and databases, and thereby improve clinical decision making.

Place, publisher, year, edition, pages
Journal of Drugs in Dermatology, 2022
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-218267 (URN)10.36849/JDD.6789R1 (DOI)000847393500012 ()35946982 (PubMedID)2-s2.0-85136339956 (Scopus ID)
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-01-04Bibliographically approved
Geale, K. & Schmitt-Egenolf, M. (2022). Severity of psoriasis: time to disentangle severity from symptom control [Letter to the editor]. British Journal of Dermatology, 186(6), 1033-1034
Open this publication in new window or tab >>Severity of psoriasis: time to disentangle severity from symptom control
2022 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 186, no 6, p. 1033-1034Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2022
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-191727 (URN)10.1111/bjd.21023 (DOI)000787084100001 ()35048366 (PubMedID)2-s2.0-85131701899 (Scopus ID)
Available from: 2022-01-24 Created: 2022-01-24 Last updated: 2022-06-20Bibliographically approved
Ortsäter, G., De Geer, A., Rieem Dun, A., Geale, K., Lindberg, I., Thyssen, J. P., . . . Neary, M. P. (2022). Societal economic burden and determinants of costs for atopic dermatitis. JEADV Clinical Practice, 1(4), 326-343
Open this publication in new window or tab >>Societal economic burden and determinants of costs for atopic dermatitis
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2022 (English)In: JEADV Clinical Practice, E-ISSN 2768-6566, Vol. 1, no 4, p. 326-343Article in journal (Refereed) Published
Abstract [en]

Background: Atopic dermatitis (AD) is a common inflammatory skin disease while the economic burden of AD by severity is not adequately understood.

Objective: To estimate the societal economic burden and to identify cost determinants of AD.

Methods: In this population-based, controlled cohort study in Sweden, patients with AD were identified through diagnosis codes in primary or secondary care or by dispensed medications using administrative healthcare registers. A reference cohort without AD was randomly selected from the general population. Healthcare costs (primary/secondary care visits and dispensed medication) and indirect costs (care for sick children and long-term sick leave for adults) were calculated annually. AD patients were stratified by age (paediatric [age < 12], adolescent [12 ≤ age < 18] or adult [age ≥ 18]), and severity (mild-to-moderate [M2M] or severe AD) and matched to the reference cohort.

Results: Compared with controls, the annual mean per-patient direct healthcare costs in the first year following diagnosis were €941 and €1259 higher in paediatric patients with M2M and severe AD, respectively. In the first year following diagnosis, the mean indirect cost for care of sick children was €69 and €78 higher per patient in M2M and severe AD, respectively. In adolescents with M2M and severe AD, direct healthcare costs were €816 and €1260 higher, respectively. In adults, healthcare costs were €1583 and €2963 higher in patients with M2M and severe AD, respectively and indirect costs were €148 and €263 higher compared with controls. Management of comorbid medical conditions was an important driver of incremental healthcare costs. Total incremental societal economic burden for AD was €351 and €96 million higher in patients with M2M and severe AD, respectively, compared to controls.

Conclusion: AD is associated with a significant societal economic burden primarily driven by the cost burden of M2M AD due to the high prevalence of this population. Regardless of severity level, management of non-AD comorbidities is a major driver of total costs.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
atopic dermatitis, economic burden, eczema, epidemiology, healthcare costs, indirect costs, public health research
National Category
Dermatology and Venereal Diseases Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-219539 (URN)10.1002/jvc2.74 (DOI)2-s2.0-85181477543 (Scopus ID)
Funder
Pfizer AB
Available from: 2024-01-16 Created: 2024-01-16 Last updated: 2024-01-16Bibliographically approved
Ortsäter, G., De Geer, A., Geale, K., Rieem Dun, A., Lindberg, I., Thyssen, J. P., . . . Neary, M. P. (2022). Validation of Patient Identification Algorithms for Atopic Dermatitis Using Healthcare Databases. Dermatology and Therapy, 12, 545-559
Open this publication in new window or tab >>Validation of Patient Identification Algorithms for Atopic Dermatitis Using Healthcare Databases
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2022 (English)In: Dermatology and Therapy, ISSN 2193-8210, Vol. 12, p. 545-559Article in journal (Refereed) Published
Abstract [en]

Introduction: The use of real-world data offers a possibility to perform large-scale epidemiological studies in actual clinical settings. Despite their many advantages, administrative databases were not designed to be used in research, and the validation of diagnoses and treatments in administrative databases is needed. The primary objective of this study was to validate an existing algorithm based on dispensed prescriptions and diagnoses of skin conditions to identify pediatric patients with atopic dermatitis (AD), using a diagnosis of AD in primary care as a gold standard.

Methods: Retrospective observational data were collected from nation-wide secondary care and pharmacy-dispensed medication databases and two regional primary care databases in Sweden. An existing algorithm and a Modified algorithm, using skin-specific diagnoses from secondary care and/or pharmacy-dispensed prescriptions to identify patients with AD, were assessed. To verify the presence of AD, diagnoses from primary care were used in the base case and complemented with diagnoses from secondary care in a sensitivity analysis.

Results: The sensitivity (30.0%) and positive predictive value (PPV) (40.7%) of the existing algorithm were low in the pediatric patient population when using primary care data only but increased when secondary care visits were also included in the Modified algorithm (sensitivity, 62.1%; PPV, 66.3%). The specificity of the two algorithms was high in both the base case and sensitivity analysis (95.1% and 94.1%). In the adult population, sensitivity and PPV were 20.4% and 8.7%, respectively, and increased to 48.3% and 16.9% when secondary care visits were also included in the Modified algorithm.

Conclusion: The Modified algorithm can be used to identify pediatric AD populations using primary and secondary administrative data with acceptable sensitivity and specificity, but further modifications are needed to accurately identify adult patients with AD.

Place, publisher, year, edition, pages
Adis, 2022
Keywords
Atopic dermatitis, Patient identification, Primary care, Validation
National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology
Identifiers
urn:nbn:se:umu:diva-191879 (URN)10.1007/s13555-021-00670-1 (DOI)000743822400002 ()35041157 (PubMedID)2-s2.0-85123107229 (Scopus ID)
Available from: 2022-01-28 Created: 2022-01-28 Last updated: 2022-08-04Bibliographically approved
Morcos, E., Falconer, C., Grip, E. T., Geale, K., Hellgren, K., Poutakidis, G. & Altman, D. (2021). Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse: a 5-years comparison between single- versus multicenter use. International Urogynecology Journal, 32(11), 3007-3015
Open this publication in new window or tab >>Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse: a 5-years comparison between single- versus multicenter use
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2021 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 32, no 11, p. 3007-3015Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: The aim of this study was to evaluate whether high surgical volume at a single center was associated with lower healthcare costs compared to lower surgical volume in a multicenter setting.

Methods: All patients had symptomatic and anatomical apical prolapse (POP-Q ≥ stage II) with or without cystocele and were operated on by a standard surgical procedure using the Uphold mesh. Data on time of resource use in terms of surgery time, hospital stay and re-interventions across 5 years were compared between the single center (97 patients) and multicenter (173 patients, at 24 clinics). Unit costs for surgical time, inpatient and outpatient visits were extracted from the single-center hospital’s operation analysis program and prime production cost. Total costs were estimated for primary surgery and during 5-year follow-up.

Results: Costs for primary surgery were comparable between the single and the multicenter ($13,561 ± 2688 and $13,867 ± 1177, P = 0.29). Follow-up costs 5 years after primary surgery were 2.8 times higher at the multicenter than single center ($3262 vs. $1149, P < 0.001). Mean cost per patient over 5 years was significantly lower at the single than multicenter [$14,710 (CI: 14,168–15,252) vs. $17,128 (CI: 16,952–17,305), P < 0.001)].

Conclusions: Using a mesh kit for apical pelvic organ prolapse in a high surgical volume center was associated with reduced healthcare costs compared with a lower volume multiple-site setting. The cost reduction at the high surgical volume center increased over time because of lower surgical and medical re-intervention rates for postoperative complications and recurrence.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2021
Keywords
Centralization, Health-care costs, Surgery volume, Vaginal prolapse mesh
National Category
Obstetrics, Gynecology and Reproductive Medicine Surgery
Identifiers
urn:nbn:se:umu:diva-181531 (URN)10.1007/s00192-021-04698-x (DOI)000622249200006 ()33635348 (PubMedID)2-s2.0-85101769947 (Scopus ID)
Funder
Swedish Research Council
Available from: 2021-04-07 Created: 2021-04-07 Last updated: 2022-04-28Bibliographically approved
Ortsater, G., Geale, K., Dun, A. R., Cappelleri, J. C., Cha, A., Romero, W., . . . Neary, M. P. (2021). Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case-Control Study in Sweden. Dermatology and Therapy, 11, 161-172
Open this publication in new window or tab >>Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case-Control Study in Sweden
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2021 (English)In: Dermatology and Therapy, ISSN 2193-8210, Vol. 11, p. 161-172Article in journal (Refereed) Published
Abstract [en]

Introduction: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by pruritic, eczematous lesions. Recent evidence suggests that AD may be a systemic disorder, implying that management of this disease extends beyond merely controlling symptoms associated with AD. Even though this disease is highly prevalent in children and patients typically present with mild-to-moderate symptoms, the disease burden is not well established.

Methods: A large, retrospective cohort study of Swedish population data was conducted to compare the clinical burden in terms of healthcare resource use and direct medical costs for pediatric mild-to-moderate (pM2M) AD patients (<= 14 years of age, N = 87,721) with matched controls. The burden of a severe AD cohort was also evaluated. Severity of AD was defined by treatment usage and systemic treatment was used as a proxy for severe AD. A robust approach was used by including any type of secondary care visits known to be more common in AD patients than in the general population; however, data for primary care visits were not available.

Results: For healthcare resource use, the incidence rate ratio (pM2M AD versus reference cohort) of secondary care visits ranged from 1.56 to 2.35 during each of 5 years after AD onset (all p < 0.001), with largest differences seen in years 1-2. The average direct medical cost (SD) was euro1111 (3416) and euro524 (2446) in the pM2M AD and reference cohorts, respectively. The corresponding estimate in the severe AD cohort was euro1906 (7067). Including all secondary care visits and pharmacy-dispensed medications, the pM2M AD cohort was shown to have an additional euro118.9 million in direct medical costs over 5 years compared with the reference cohort.

Conclusions: This study shows significant clinical and economic burden of pM2M AD with important secondary care resource utilization, suggesting a need for further research to increase treatment options and improve the management of these patients.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
Atopic dermatitis, Epidemiology, Public health research, Pediatrics
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-178691 (URN)10.1007/s13555-020-00470-z (DOI)000600083600002 ()33337521 (PubMedID)2-s2.0-85097734331 (Scopus ID)
Available from: 2021-01-14 Created: 2021-01-14 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7241-8471

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