Economic impact of skin disease attracts Congressional attention

In April, approximately 40 Congressional staff and representatives from specialty medical societies along with two members of Congress attended the Academy’s briefing in Washington, DC on the economic impact of skin disease and how the specialty is working to improve access issues. Academy President Henry Lim, MD, and Karen Edison, MD, presented findings from the Academy’s Burden of Skin Disease report, a research study that examines the impact of skin disease in the United States, and the new SkinSerious campaign, an effort to raise awareness about the breadth of skin diseases that affect patients, improve access to dermatologic care, and highlight the role dermatologists play in team-based care. Member to Member discussed the event with Dr. Lim, chair of the Burden of Skin Disease Work Group.

In March, the Journal of the American Academy of Dermatology (JAAD) published, “The Burden of Skin Disease in the United States,” the first in a series of three articles of the report. The second of the series, “Contributions of health care factors to the burden of skin disease in the United States,” is now available in JAAD.

Member to Member: What issues did you focus on in your address to Congressional representatives and staff?

dr-henry-w-lim-md.jpgDr. Lim: We focused on the fact that now we have very good scientific data that establishes the burden of skin disease figures. We used 2013 claims data, which is the latest data available for analysis. Based on input from key stakeholders from within the dermatology community, we divided dermatology diseases into 24 categories and looked at the economic burden of those diseases. We reviewed the burden from direct costs and indirect costs.

There were several key findings, including:

  • Approximately 25 percent of the U.S. population, or 85 million Americans, received treatment for skin disease in 2013.
  • Nearly 50 percent of American older than 65 had skin disease in 2013, and they had an average of two diseases per person.

The Academy is creating briefs on the 24 skin disease categories examined in the 2016 Burden of Skin Disease report. The briefs are complimentary and available for informational purposes only.
These findings indicate that skin disease is a very common condition. It is more common than cardiovascular disease, diabetes, and end-stage renal disease.

The data also confirms what we as dermatologists already know: skin disease is very serious with significant consequences for morbidity and mortality. One half of the skin categories we analyzed were associated with mortality. Within that category, 60 percent of the deaths were caused by skin cancer.

We found that the cost of skin disease to society is very high. In terms of direct costs, in 2013, $75 billion dollars was spent on skin disease. This includes cost for direct care of skin disease, prescription drugs, as well as over-the-counter treatments.

Looking at the indirect costs, specifically in terms of loss of productivity for either the patient or the caregiver, the total is $11 billion.

It’s a very expensive disease with high economic impact.

Another aspect that is quite revealing is that two out of three patients with skin disease were treated by non-dermatologists. We have only approximately 10,000 board-certified dermatologists in the U.S., and we need about 20,000 dermatology clinicians to care for all the patients with skin diseases.

Therefore, there is a challenge for us as a specialty in terms of how to improve access for patients with skin disease. Access issues will be a major focus during my 2017-18 term as Academy president.

M2M: What was the response from legislators and their staff who attended the briefing?

Dr. Lim: The response was very positive. There were two Congress people in attendance along with Congressional staff and other health care advocates. They seemed to be impressed by the impact of skin disease.

One of the staffers asked what Congress could do to help us address the burden issues. My answer was that we need to advocate for and support research funding for dermatology so that we can continue to develop better treatments. This will minimize the suffering of patients and the cost of medical care.

We were asked what can be done about the mortality rates related to skin cancer. I addressed the efforts the Academy has made in educating the public about the dangers of tanning, and that we’d like Congressional support to restrict indoor tanning.

A new website features resources on the Burden of Skin Disease including complimentary briefs and the opportunity to license the full report.
We were also asked about sunscreen and the approval process for new filters in sunscreen. I explained that the FDA has not approved any new ingredients for about the past 15 years and we are working with the sunscreen industry to try to facilitate the approval process. But right now it is not moving very far.

Burden of Skin Disease website

The Academy has launched the Burden of Skin Disease website that offers resources related to the report, including:

The report is being released in conjunction with the Academy’s new SkinSerious campaign, which aims to raise awareness of the impact of skin disease, as well as the critical role dermatologist play in the era of team-based care.

Report includes analysis of 24 disease categories

The 2016 Burden of Skin Disease report, commissioned by the American Academy of Dermatology, examined prevalence, economic burdens, and mortality for skin disease in the U.S. using 2013 health care claims data drawn from insurance enrollment and claims databases. The scope of this analysis was to study the burden of skin disease relevant to the practice of dermatology, as well as to other providers treating the skin.

The full Burden of Skin Disease report includes analysis of 24 disease categories:
1. Acne (cystic and vulgaris)
2. Actinic damage
3. Atopic dermatitis, eczema
4. Benign neoplasms, keloids, scars, cysts
5. Bullous diseases
6. Congenital abnormalities (including hemangiomas)
7. Connective tissue diseases
8. Contact dermatitis (including occupational)
9. Cutaneous infections (including impetigo, cellulitis, abscesses, and other bacterial or mycobacterial infections)
10. Cutaneous lymphoma
11. Drug eruptions
12. Hair and nail disorders
13. Human papillomavirus (HPV) infections/warts and mollusca contagiosa
14. Melanoma
15. Non-melanoma skin cancer
16. Pruritus
17. Psoriasis
18. Rosacea
19. Seborrheic dermatitis
20. Ulcers
21. Urticaria
22. Viral (herpes simplex [HSV] and herpes zoster [HZV]) and fungal diseases
23. Vitiligo
24. Wounds and burns