P2A039: A Retrospective Claims Analysis of US Pediatricians Prescribing Practices for the Treatment of Molluscum Contagiosum

Background: Molluscum contagiosum (MC), a common viral skin infection affecting mostly children, is caused by the Molluscipoxvirus. Flesh-colored, round, dome-shaped, slightly umbilicated bumps may appear anywhere on the body. MC is transmitted via skin-to-skin contact with infected persons or contaminated objects. Molluscum infections may last months to years; inflammation frequently precedes resolution (Beginning of the End “BOTE” sign). Pediatricians are often the first to diagnose MC, but there is an absence of molluscum management guidelines and FDA-approved medications. The gold standard for MC management is no treatment.

This analysis examined claims data to understand MC treatment management practices of pediatricians in the United States.

Methods: Syneos Health Consulting Insight Suites used the Compile Claims database to collect all medical and pharmacy claims for pediatric patients newly diagnosed with molluscum (ICD10 Code B081) in 2019 and 2020. All medical and pharmacy claims for these patients in the 365 days after their first molluscum diagnosis were captured.

The number of pediatric patients who had a Molluscum (B081) claim with a pediatrician (pediatrician included nurse practitioners and physician assistants associated with a pediatric practice or having a pediatric specialization) was calculated along with the number of patients prescribed a prescription by the same pediatrician within 30 days of the molluscum claim. Only paid pharmacy claims were included. Pharmacy claims do not specify the condition the medication(s) are prescribed, therefore we anchored to the medical claims, which do contain diagnosis information, and used a 30-day period to identify prescriptions likely being used off label to treat molluscum.

Results: From 2019-2020, 260,788 molluscum patients ≤19 years were diagnosed by 56,026 healthcare providers. Pediatricians were responsible for a majority of molluscum diagnoses: 72% of patients (187,228) diagnosed by 35,017 pediatricians.

91.0% (31,968) of pediatricians managed MC by “wait and see” (no therapy or referrals). 8.0% (2,783) of pediatricians were “treaters” (initiating treatment at diagnosis); and 0.8% (266) routinely referred to another provider.

Of the “pediatrician treaters,” 5% (1500) treated over 2/3 (>67%) of their MC patients.

If a “wait and see” pediatrician initiated treatment, half managed by prescription therapy, whereas “treaters” used in-office procedures (81%) and prescriptions (23%).

Mupirocin (43%) and triamcinolone (22%) were preferred prescriptions regardless of MC treatment approach.

Conclusion: 260,788 pediatric MC claims occurred in 2019-2020. The number of MC claims may be underestimated due to the impact of COVID and because most pediatricians do not treat MC and therefore may not code for reimbursement. Mupirocin and triamcinolone were most often prescribed, likely to treat inflammation that often precedes MC resolution. However, neither are FDA approved for MC and mupirocin resistance and ineffectiveness against viral infections is concerning. Development of molluscum management guidelines may foster both preventive and consistent treatment strategies to reduce contagiousness among children.