A Systematic Literature Review of Economic Evaluations and Cost Studies of the Treatment of Psoriasis, Atopic Dermatitis, and Chronic Urticaria

Abstract

Introduction Psoriasis (PSO), atopic dermatitis (AD), and chronic urticaria (CU) are common manifestations of immunological skin and subcutaneous conditions and have been shown to have a substantial impact on the quality of life of patients. The cost of treating those conditions can also be high, as the use of biologic treatments has become more common for moderate to severe patients. In this review, we examine characteristics of economic evaluations and cost studies conducted for the three conditions. Methods A literature search was conducted using PubMed, Embase, and the Cochrane Library from January 1, 2016 to October 26, 2020 to identify economic evaluations where the cost of one or more drug treatment was evaluated and cost studies covering any intervention type. Each database was searched using keyword and MeSH terms related to treatment costs (e.g., health care cost, drug cost, etc.) and each condition (e.g., PSO, AD, eczema, CU, etc.). Results A total of 123 studies were reviewed, including 104 studies (85%) of PSO (including psoriasis, plaque psoriasis, psoriatic arthritis, and psoriasis vulgaris), 14 studies (11%) of AD, and 5 studies (4%) of CU. Seventy-two studies (59%) reviewed reported the inclusion of biologic treatments, 10 studies (8%) did not include biologic treatments, and 41 studies (33%) did not report whether or not a biologic treatment was included. While nearly all studies (98%) included direct costs, only 22 studies (18%) included indirect costs. Conclusions Economic evaluations for AD and CU may be needed in order to better understand the value of new treatments. Moreover, a clearer delineation for biologic treatments and indirect costs (i.e., productivity losses and gains) may be required. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00774-2.

Cost-of-illness of adult atopic dermatitis from a societal perspective in Hungary

“…An extensive literature of cost of illness studies is available in various dermatological conditions and several disease burden and cost of illness studies have been conducted in AD worldwide [11]. In a Japanese cross-sectional survey with physicians, the mean annual expected cost per patient was JPY 136 501 [38].…”

“…To each EQ-5D-5L health pro le, an index score can be attached, for which we used the country speci c value set for Hungary [23]. The DLQI questionnaire is a dermatology-speci c self-reported questionnaire [11], containing of ten items covering the common problems affecting HRQoL of patients with skin disease. Each item is scored on a 4-point scale: 'not at all' or 'not relevant' = 0, 'a little' = 1, 'a lot' = 2 and 'very much' = 3; and the total DLQI score is calculated by summing up the scores of all questions, resulting in a maximum score of 30 and a minimum score of 0, where the higher the score, the more impaired the patient's HRQoL is.…”

“…AD impacts patient's health-related quality of life (HRQoL) greatly and causes signi cant burden from both direct and indirect costs on an individual and societal level [4][5][6][7][8][9][10]. A recent review highlights that economic evaluations for AD may be needed in order to better understand the value of new treatments [11]. In a global burden of disease burden study, in the United States, a signi cant proportion of total burden measured in DALYs was accountable for dermatitis (atopic, contact, and seborrheic dermatitis) [12].…”

Societal costs and health related quality of life in adult atopic dermatitis

“…The DLQI questionnaire is a dermatology-specific self-reported questionnaire [ 11 ] containing ten items that cover the common issues that affect the HRQoL of patients with skin diseases. Each item on the DLQI is scored on a 4-point scale: ‘not at all’ or ‘not relevant’ = 0, ‘a little’ = 1, ‘a lot’ = 2 and ‘very much’ = 3.…”

“…AD significantly impacts a patient’s health-related quality of life (HRQoL) and results in a substantial burden of both direct and indirect costs on both an individual and societal level [ 4 – 10 ]. A recent review highlights that economic evaluations for AD may be needed in order to better understand the value of new treatments [ 11 ]. According to a global study on disease burden, a significant portion of the total burden measured in disability adjusted life-years (DALYs) in the United States is attributed to dermatitis, including atopic, contact and seborrheic dermatitis [ 12 ].…”