Dr Geetika Seth

Media summary

Our study is a large, retrospective review to assess the utility of the Waikato District Health Board (DHB) dermatology department’s out-patient service. This study assesses the drug survival of all systemic agents used in dermatology for various skin conditions from January 2016 to December 2020. The study will quantify the effectiveness of dermatology outpatient service and help us identify the factors leading to poor drug survival. Rectifying these factors will help improve quality of dermatology service and possibly reduce the overall disease burden.

Drug survival (DS) studies are used to evaluate real-world effectiveness of drugs. Drug survival is the time from its initiation to its termination. It is a surrogate marker of drug performance in real-life conditions. It gives information of efficacy, safety and adherence, which are critical in disease management. The hospital practice of dermatology in New Zealand primary deals with chronic inflammatory diseases such as psoriasis and eczema, for which a successful drug will often be required for months, years, or indefinitely.

There is limited New Zealand data on long-term efficacy, safety, and drug survival rates of systemic therapies in dermatology.

Outcome Statement

Systemic drugs play an important role in the modern practice of dermatology. With rising health care costs, health professionals seek better methods to evaluate treatment options – which remain few for most dermatological conditions. The selection of a drug depends on its effectiveness, safety, and patients’ and doctors’ preferences. Drug survival rates should be integrated into therapeutic decisions. The hospital practice of dermatology in New Zealand primarily deals with chronic inflammatory diseases such as psoriasis and eczema, for which a successful drug will often be required for months, years, or indefinitely.

Drugs may be discontinued for many reasons including lack of efficacy, adverse effects, patient factors, and clinical success. They may be discontinued because the patient or doctor fails to renew the prescription for an unknown reason, or because the patient moves out of the area. They may develop real or perceived drug-related side effects, or another illness may intervene. In some cases, it can be difficult to determine why the drug was terminated.

Waikato DHB receives referrals from a large population and our services are limited with the high demand. Most patients seen in the dermatology service require systemic agents for treatment of their skin condition. Drug survival study will give us a better understanding of the disease burden and also about the reason the medications are stopped.

The reasons for decreased drug survival will give us a better understanding of how we can improve the drug survival in order to reduce disease burden, eg. if lack of follow-up is the main reason for drug discontinuation we could address it via a general practitioner driven telemedicine service.

In addition, ethnic identity is an important dimension of health inequalities Maori health status is demonstrably poorer than other New Zealanders; actions to improve Maori health also recognise Treaty of Waitangi obligations of the Crown; in addition, general and geographical inequalities are important areas for action. This study will help us understand and address these socioeconomic, ethnic, gender and geographic inequalities in terms of drug survival and help us to determine how they can be tackled to improve health.