Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermatological Practice in Two German Federal States

Abstract

The globally increasing prevalence of chronic inflammatory skin diseases has substantial costs. Biologicals have become available as therapeutic options, but are encumbered with barriers to prescription. The aim of this study was to evaluate the barriers to prescription of biologicals in the treatment of chronic dermatological diseases. Dermatologists working in private practices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional study. Economic and legal aspects, including “high therapy costs”, “low reimbursements”, and “fear of regress claims”, were identified as the most prevalent barriers. Significant differences between dermatologists from Bavaria and Lower Saxony were found only regarding the treatment of atopic dermatitis. This study demonstrates the prevalence of barriers to the prescription of biologicals in the treatment of chronic dermatological diseases. Overcoming these barriers could improve the usage of modern therapies and thereby expand patient-centred care for chronic skin diseases.

Dermatologists' perspectives on healthcare of patients with atopic dermatitis: A cross‐sectional study in Germany

“…11,16 The rate of patients receiving biologicals was comparable to that of another German study 7 but lower than reported before (8%-11%). 11,16 One explanation may be that this study asked about the proportion among all patients, whereas the other two studies focused on patients with moderate-to-severe AD. Another explanation could be that only dermatologists from Bavaria were considered, who prescribe biologics less commonly compared to dermatologists from other German federal states.…”

“…Additionally, almost one-third of dermatologists were dissatisfied with therapy costs, which were previously shown to be an obstacle for the prescription of emollients and biologicals. 11,16 The rate of patients receiving biologicals was comparable to that of another German study 7 but lower than reported before (8%-11%). 11,16 One explanation may be that this study asked about the proportion among all patients, whereas the other two studies focused on patients with moderate-to-severe AD.…”

“…Although biologicals are recommended in moderate‐to‐severe AD, 9,15 only one in ten dermatologists believed they were most effective in patients with moderate AD. Additionally, almost one‐third of dermatologists were dissatisfied with therapy costs, which were previously shown to be an obstacle for the prescription of emollients and biologicals 11,16 . The rate of patients receiving biologicals was comparable to that of another German study 7 but lower than reported before (8%–11%) 11,16 .…”

“…However, previous surveys among dermatologists had comparable response rates. 16,19,20 The results indicated that there is still potential to improve AD healthcare, especially for patients with severe AD. Furthermore, from the dermatologists' perspectives, using the internet for health information is useful for disease awareness, but it rather negatively influences other important and primarily therapeutic aspects of healthcare.…”

Limited Reimbursement and Underuse of Digital Healthcare Concepts Are Major Barriers to Clinical Allergological Care in Germany

“…Notably, the financial aspect may cause more unmet medical needs in allergological care in comparison with those in financially more attractive fields of medicine. Financial barriers have been identified as being present in all aspects of care, from the general availability of allergological care, to diagnostics or the prescription of efficient medicine [27, 40]. Although Germany currently has a relatively high number of allergologists, the number of specialists is continually decreasing [7].…”