Immune-Response Modifiers: Characteristics of High-Volume Prescribers.

BACKGROUND: Oral small molecules (OSM) and biologic immune response modifier drugs share some indications for use but have a different side effect profiles. As such, certain providers may be more likely to prescribe one over the other. OBJECTIVE: To investigate the profile of providers who are high-volume prescribers of OSMs and biologic immune response modifier drugs. METHODS: The study was comprised of a retrospective analysis of data from physicians in the Medicare Provider Utilization and Payment Data: Part D Prescriber. RESULTS: Out of 14,982 dermatology providers, 424 prescribed both more than 1000 patient-days' supply of OSMs and more than 1000 patient-days' supply of biologic immune modifiers annually. For both OSMs and biologic immune modifiers, being male or being a provider with more than 4 years of experience were each found to be statistically significant characteristics of high-volume prescribers (P<.01). Solo or group practice was not a significant characteristic for high-volume prescribers of OSMs or biologic immune response modifiers; but when comparing the average provider prescribing OSMs with the average provider prescribing biologic immune response modifiers, those prescribing OSMs were more likely to be working in a group practice. CONCLUSION: The 4 years' post-residency may be instrumental in helping providers become more comfortable in prescribing high volumes of biologic immune modifiers and OSMs. In addition, the higher volume prescriptions of both immune response modifiers by males may be due to males being more risk tolerant. J Drugs Dermatol. 2022;21(12):1283-1288. doi:10.36849/JDD.6891R1.

Risk Factors That Are Associated With Outliers in Mohs Micrographic Surgery in the National Medicare Population, 2018.

BACKGROUND: Physician variation exists in the mean number of stages performed per Mohs micrographic surgery (MMS) case. Physicians who are outliers in medical practice may be leading to a higher health care cost burden. OBJECTIVE: To identify factors that influence being a high outlier in the mean stages per MMS case. MATERIALS AND METHODS: The study comprised a retrospective analysis of 2018 data from physicians who billed Medicare Part B for Current Procedural Terminology (CPT) 17311 and 17312 (MMS of the head, neck, hands, feet, or genitalia) and/or CPT 17313 and 17314 (MMS of the trunk, arms, or legs). RESULTS: For CPT 17311 and 17312, the odds ratio for being an outlier for a physician in a solo practice relative to a multiphysician facility is 2.4 (1.6-3.8), for a physician who is not an American College of Mohs Surgery (ACMS) member relative to a ACMS member is 2.0 (1.2-3.2), and for a practice located in the West, Northeast, and South is 7.7 (2.8-21.6), 6.2 (2.1-18.6), and 1.8 (0.6-5.4), respectively, relative to in the Midwest. CONCLUSION: Physicians who are practicing solo, practicing in the West or Northeast, and are not ACMS members are more likely to be a high outlier in the mean stages per MMS case.

United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019.

BACKGROUND: Skin cancer is the most common cancer worldwide. OBJECTIVE: To evaluate the burden of skin cancer in the US from 1990 to 2019. METHODS: Age-standardized incidence, prevalence, disability-adjusted life years (DALY), and mortality rates from skin cancer in the US were evaluated from the Global Burden of Disease 2019. RESULTS: Incidence, prevalence, DALY, and mortality rates for melanoma per 100,000 persons in 2019 were 17.0, 138, 64.8, and 2.2, respectively; for squamous cell carcinoma, rates were 262, 314, 26.6, and 0.8, respectively; and for basal cell carcinoma, rates were 525, 51.2, 0.2, and zero, respectively. Incidence and prevalence rates of melanoma and non-melanoma skin cancer (NMSC) have increased since 1990, while mortality rates have remained fairly stable. Males have had higher incidence, prevalence, DALY, and mortality rates from melanoma and NMSC every year since 1990. Incidence and prevalence of melanoma was relatively higher in the northern half of the US than in the southern half. LIMITATIONS: Global Burden of Disease is derived from estimation and mathematical modeling. CONCLUSIONS: Health care professionals can utilize differences and trends noted in this study to guide allocation of resources to reduce incidence and morbidity from skin cancer.