December 21, 2018

It is crucial to identify effective strategies for improving the management and control of pruritus.

Elucidating the healthcare costs associated with pruritus is critical, considering the association of itch with numerous chronic diseases. Incremental costs linked with pruritus seem to have remained steady over the years, but expenditures resulting from the condition appear to be shifting from outpatient and inpatient settings to the emergency department and home health services.

For this study, researchers examined pruritus-associated healthcare expenditures in the United States using 9 years of data from the Medical Expenditure Panel Survey for 2007 through 2015. Findings from the current retrospective cohort study were published in the Journal of the American Academy of Dermatology. 

The investigators sought to provide nationally representative estimates of the incremental healthcare burden of pruritus, controlling for sociodemographic characteristics and patient comorbidities. They used the definition of pruritus from the International Classification of Diseases, 9th Revision, Clinical Modification code 698. A 2-part linear regression model was used to account for the high concentration of zero expenditures reported in the data. The model is used to estimate expenditure ratios.

A total of 637 patients with pruritus and 288,061 individuals without pruritus were included in the study sample. The following groups were all significantly more likely to have pruritus: women, older adults, Medicaid/Medicare patients, non-white patients, patients with more comorbidities, and patients with less education (P <.001 for all). After controlling for all sociodemographic factors and the Charlson Comorbidity Index, the cost of care among patients with pruritus was 1.64 times as high as costs among those without the condition (P <.001).

The analysis showed that ultimately, pruritus can become a significant burden to both medical and financial health. Patients with pruritus are estimated to incur $4843.68 more in annual healthcare costs compared with those without pruritus, even after controlling for sociodemographic factors and comorbidities.

A major limitation of the study is that unmeasured confounders may have overestimated the incremental cost associated with pruritus, taking into account the demographic differences between the evaluated patient populations with and without pruritus.

The investigators concluded that as overall healthcare costs continue to rise, it is even more critical to identify effective strategies to improve the management and control of pruritus.

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Reference

Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. The cost of an itch: a nationally representative retrospective cohort study of pruritus-associated healthcare expenditure in the United States [published online October 23, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.10.025