Where you live matters: Regional differences in health care resource use for psoriasis in the United States.

BACKGROUND: It is unknown which U.S. Census region offers the best access to health care resources. OBJECTIVE: To compare health care resource use and costs for patients with psoriasis among the 4 U.S. Census regions. METHODS: Cross-sectional study using the 1996-2015 Medical Expenditure Panel Survey. RESULTS: In the United States the greatest access for biologic medications was in the South (9.1% receiving biologic medications/year), followed by the Northeast (7.4%), the West (6.8%), and the Midwest (5.2%). Ambulatory visits per patient per year were highest in the West (5.02), followed by the Northeast (3.81), the South (2.95), and the Midwest (2.84). The proportion of patients with ≥1 emergency department (ED) visits was highest in the Northeast (2.73%), followed by the West (2.17%), the South (1.19%), and the Midwest (1.17%). Compared with the remainder of the country, the West incurred the lowest total health care costs (P = .035) and the lowest drug costs (P = .023); and the Northeast incurred the highest total health care costs (P = .050) and the highest ambulatory costs (P < .001). Although the South had the greatest proportion of patients using biologic medications (9.1% vs 6.4%, P = .045), it also had 30% fewer ambulatory visits per patient per year and a 39% lower proportion of ED visits for psoriasis. LIMITATIONS: Data for psoriasis severity were unavailable. CONCLUSIONS: Southern U.S. states have the greatest access to biologic medications and incurred fewer ambulatory and ED visits. The Midwest had the lowest access to biologic medications and ambulatory and ED care. The West incurred the lowest total health care costs, while the Northeast incurred the highest total health care costs.

Does location matter? Geographic variations in healthcare resource use for atopic dermatitis in the United States.

BACKGROUND: It is unknown which region of the U.S. offers the best and worst access to care for atopic dermatitis (AD). METHODS: We conducted a cross-sectional study using the Medical Expenditure Panel Survey (MEPS) from 1996 to 2015 to compare healthcare resource use and cost of AD among U.S. census regions. We conducted multivariable regression analyses adjusting for clinicodemographic factors to evaluate regional differences in healthcare resource use and cost per patient per year (PPPY) in terms of ambulatory visits, ED visits, and medications directly attributable to AD. RESULTS: An estimated total of 6,348,578 (95% CI: 5,944,553-6,752,803) AD patients (weighted) were pooled. Compared to the remainder of the country, Midwest AD patients utilized the fewest ambulatory visits (0.55 versus 0.75 visits PPPY; p = .035). The proportion of patients with ≥1 ED visits was highest in the Midwest (7.1%), followed by the South (5.4%), Northeast (4.8%), and West (1.4%). Within the Midwest AD population, those with no ambulatory visits per year utilized nearly three times more ED visits when compared with those with one or more ambulatory visits per year (0.11 versus 0.04 visits PPPY; p = .019). CONCLUSION: Our results suggest that Midwest AD patients have differential access to outpatient care, which may be resulting in higher ED usage.