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Mori WS, Houston N, Moreau JF, et al. Personal Burden of Isotretinoin Therapy and Willingness to Pay for Electronic Follow-up Visits. JAMA Dermatol. 2016;152(3):338–340. doi:10.1001/jamadermatol.2015.4763
The requirements that iPLEDGE, a computer-based risk management program (http://www.ipledgeprogram.com), places on prescribing isotretinoin typically mean that patients are seen on a monthly basis in the physician’s office for 5 to 6 months,1 which may lead to time and financial burdens on patients and caregivers, such as missed work and school. To our knowledge, these losses of time have not previously been quantified in the literature. Electronic visits (e-visits) represent a potential alternative to some follow-up visits for patients enrolled in the iPLEDGE program. Such e-visits have been shown to have utility for follow-up appointments among patients with acne, resulting in equivalent patient satisfaction compared with face-to-face appointments with a physician.2-4 To our knowledge, the patient’s and/or caregiver’s interest and willingness to pay for e-visits, which is especially important for the financial feasibility of such visits, have not been measured in patients prescribed isotretinoin. We used a survey to quantify the perceived burden of follow-up visits, as well as interest in, perceived safety of, and willingness to pay for e-visits.
The study was determined to be exempt from full review by the University of Pittsburgh Institutional Review Board. Descriptive statistics were generated based on responses to an anonymous survey conducted at 3 academic clinic sites between April 1 and October 31, 2014, of 62 patients 18 years or older and 43 caregivers of patients younger than 18 years who had been taking isotretinoin for at least 3 months. Verbal consent for completing the survey was obtained from the participants and the surveys were completed anonymously such that respondent identity could not be determined based on individual survey responses. Data analysis was performed from December 1, 2014, to March 31, 2015.
Most respondents had commercial health insurance (71 of 98 [72.4%]) and reported an annual income of $50 000 or less (52 of 99 [52.5%]) (Table 1). Most patients and caregivers reported that office visits caused them to miss school or work (Table 2). Among the respondents who missed work, e-visits were estimated to save a median of 2 hours (interquartile range, 0-3 hours) of work monthly. Among pediatric patients, caregivers estimated that e-visits would reduce missed school time by a median of 3 hours monthly (interquartile range, 2-3.5 hours). Most respondents reported no concern about the safety of an e-visit compared with that of an office visit. When given a choice of cost for an e-visit ($25, $50, $75, $100, $150, and $200), 40 respondents (38.1%) were unwilling to pay any amount out of pocket for an e-visit, and 64 (61.0%) were willing to pay a median amount of $25. Respondents were asked to estimate the total cost of attending an office visit, including copayment, lost income, and cost of travel and parking. This total cost was a mean of $31.90 for those with an annual income of $50 000 or less and $41.83 for those with an annual income of more than $50 000.
Our findings show that monthly office visits for isotretinoin treatment place time and financial burdens on most patients and caregivers in the form of hours of work and school missed, lost wages, and travel costs. Most of those surveyed were interested in, comfortable with the safety of, and willing to pay for e-visits. The median price of $25 per e-visit that respondents selected may not make e-visits financially feasible for the dermatologist; however, in our area, the price of e-visits for other dermatologic conditions are not much more expensive than this price point ($49-$59).5,6 It is unclear whether the price point suggested by our study is fully reflective of the willingness of respondents to pay for e-visits, as perhaps some respondents exclusively chose the lowest cost option offered ($25). In fact, we found that most respondents incurred costs greater than $25 by attending office visits. As part of the ongoing dialogue among dermatologists, the US Food and Drug Administration, and patients about the evolution of the iPLEDGE program, it is important to quantify the burden it places on patients and caregivers. In addition to financial burdens, it is notable that the average pediatric patient missed 3 hours of school each month owing to office visits. In conclusion, e-visits may be a feasible way to reduce the burden created by the iPLEDGE program for many patients taking isotretinoin.
Accepted for Publication: October 8, 2015.
Corresponding Author: Timothy J. Patton, DO, Department of Dermatology, University of Pittsburgh, 3601 Fifth Ave, Fifth Floor, Pittsburgh, PA 15213 (firstname.lastname@example.org).
Published Online: December 23, 2015. doi:10.1001/jamadermatol.2015.4763.
Author Contributions: Dr Moreau and Mr Mori had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Mori, Ferris, Patton.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Mori, Houston, Moreau, Prevost.
Critical revision of the manuscript for important intellectual content: Mori, Moreau, Gehris, Ferris, Patton.
Statistical analysis: Mori, Moreau, Patton.
Obtained funding: Mori.
Administrative, technical, or material support: Mori, Houston, Gehris, Ferris, Patton.
Study supervision: Gehris, Ferris, Patton.
Conflict of Interest Disclosures: Dr Gehris reported serving on the advisory board for Iagnosis, a teledermatology company, as well as being a low-level investor in the company. No other conflicts were reported.
Funding/Support: This study was supported by the University of Pittsburgh School of Medicine Dean’s Summer Research Program.
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: The University of Pittsburgh Clinical and Translational Sciences Institute provided counsel on the approach to statistical analysis and Matthew Hastings, PA-C, University of Pittsburgh, assisted with the acquisition of data. No compensation was provided for these contributions.
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