Cost of atopic dermatitis and eczema in the United States

Ellis, Charles N.; Drake, Lynn A.; Prendergast, Mary M.; Abramovits, William; Boguniewicz, Mark; Daniel, C. Ralph; Lebwohl, Mark; Stevens, Seth R.; Whitaker-Worth, Diane; Cheng, Jasmine; Tong, Karen A.

doi:10.1067/mjd.2002.120528

Cited by 197 publications

(116 citation statements)

References 14 publications

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“…Indeed, published studies have suggested that the BOI in patients with AD may be substantial, both in terms of economics and QOL. [1][2][3]13 Similar to the findings of Su et al, for the pediatric population in the current study, as severity of illness increased, mean per-patient cost also increased. 1 This was also true for the current adult population.…”

Section: ■■ Discussionsupporting

confidence: 79%

“…Indeed, current estimates are based upon 2 published studies. 2,3 In the study by Lapidus and colleagues, the number of visits to the hospital and associated reimbursement to the hospital for atopic dermatitis during the period 1990-1991 were projected as follows: 82 hospitalizations ($268,301), 1,144 emergency room visits ($113,229), and 672 visits to other practice settings ($28,900). The majority of visits (63%) occurred in the emergency department, and 60% of these visits occurred between 9 a.m. and 5 p.m., Monday to Friday, when outpatient clinics would have been open.…”

mentioning

confidence: 99%

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The Effect of Atopic Dermatitis on Total Burden of Illness and Quality of Life on Adults and Children in a Large Managed Care Organization

Fivenson¹

2002

JMCP

138

118

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topic dermatitis (AD) is a common childhood chronic skin condition that begins in infancy in 60% of cases. 1 Similar to asthma, the incidence of this disease has risen since the 1950s and more commonly affects urban populations. Little is known regarding the burden of illness (BOI), both in terms of resource utilization and effects on productivity in the workplace, associated with AD in the United States. Indeed, current estimates are based upon 2 published studies. 2,3 In the study by Lapidus and colleagues, the number of visits to the hospital and associated reimbursement to the hospital for atopic dermatitis during the period 1990-1991 were projected as follows: 82 hospitalizations ($268,301), 1,144 emergency room visits ($113,229), and 672 visits to other practice settings ($28,900). The majority of visits (63%) occurred in the emergency department, and 60% of these visits occurred between 9 a.m. and 5 p.m., Monday to Friday, when outpatient clinics would have been open.Approximately 60% of patients seen in the emergency room had moderate to severe disease as judged by the criteria of Rajka and Langeland, and 75% were insured by Medicaid. This study had the following limitations: (1) the majority of encounters occurred in the emergency room setting, (2) 75% of patients seen in the emergency room were covered by Medicaid, (3) costs of individual patients were not followed over time, (4) indirect costs were not considered, and (5) seasonal variation in the disease was not considered. Six-month utilization data were multiplied by 2 to obtain yearly estimates.Ellis and colleagues reported $580 per-patient direct costs for a private managed care payer, 42% of which was due to office visits, 24% for medications, 10% for outpatient hospital, and 9% for inpatient hospital. This study, while encompassing a Medicaid dataset as well as a private insurer database, encompassed only claims for AD, which may be inaccurate, and did not include indirect costs. Moreover, new therapies for AD, including topical tacrolimus 4 and pimecrolimus, 5 have recently been approved in the United States.The objective of the current study was to evaluate the magnitude of the BOI associated with AD and to identify the factors that contribute to the overall cost. This study consisted of 3 components: (1) direct cost analysis (resource use) via a retrospective electronic claims-based evaluation; (2) indirect costs and quality of life assessment via a prospective survey of patients regarding out-of-pocket expenses, patient-perceived severity of illness, productivity losses, and quality of life (QOL); and Authors A B S T R A C TOBJECTIVE: To assess the impact of atopic dermatitis (AD) on total burden of illness and quality of life in a managed care population.METHODS: This study included retrospective evaluation of electronic claims, patient surveys of financial burden and quality of life (QOL), and medical chart review. A total of 962 AD patients had 12 months of claims data available. Of these, the Dermatology Life Quality Index (DLQI), SF-3...

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Section: ■■ Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

The Effect of Atopic Dermatitis on Total Burden of Illness and Quality of Life on Adults and Children in a Large Managed Care Organization

Fivenson¹

2002

JMCP

138

118

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“…The estimated relative riskso fh avingA Ma mong AD patients in ours tudy were lowert hant hose reported in theE llise ta l. studyt hate stimated theO Rs compared with non-AD patients of 2.17 forasthma, 1.53 forallergic rhinitis,and 2.10 forallergic conjunctivitis. 10 Thed iscrepancy betweent he studiesm ay be duet od ifferencesi nt he characteristics of studyp atients andd efinitionso ft he AM conditions,s ucha sa llergicc onjunctivitis. Ellise ta l. included aM edicaidp opulationt hat, when compared with thep rivatelyi nsured patients,h ad as ignificantlyh igherp revalenceo fa sthma( 14%v s. 5%)a nd allergic conjunctivitis (7%v s. 4%).…”

Section: ■■ Discussionmentioning

confidence: 99%

“…20-6.14),c ompared with patients without AD;h owever, thesef igures representc oncomitant associations,n ot assessmentso fa topic manifestation( AM) emergence in patients whofirst developed AD. 10,13 TheprevalenceofAMs in patients with AD has been reported to be age-dependent, with approximately 43%to53% of children whos ufferedA Ds ubsequentlyd evelopinga sthmaa nd 45%t o 78%d eveloping allergicr hinitis. [14][15] Severity of AD is positively correlated with eventualA Md evelopment.…”

Section: What This Study Addsmentioning

confidence: 99%

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Economic Burden of Atopic Manifestations in Patients With Atopic Dermatitis - Analysis of Administrative Claims

Suh¹,

Sung²,

Gause³

et al. 2007

JMCP

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BACKGROUND: Atopic dermatitis (AD) has been associated with atopic manifestations (AMs), such as food allergies, asthma, allergic rhinitis, and allergic conjunctivitis.OBJECTIVES: To (1) compare the risk of developing AMs in patients with AD versus those without AD, (2) estimate the incremental costs attributable to AMs in patients with AD, and (3) examine the factors associated with incremental costs.METHODS: In this retrospective cohort study, the authors used MarketScan research databases containing medical and pharmacy claims with dates of service from January 1, 1999, to December 31, 2004. Patients were considered to have AD if they had at least 1 medical claim with a primary or secondary diagnosis of AD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 691.8x) or contact dermatitis or other eczema of unspecified cause (ICD-9-CM codes 692.9x). To create comparable study cohorts, patients with AD were matched with non-AD patients using propensity scores that represented the likelihood of developing AD as predicted by logistic regression. After propensity score matching, the AD and non-AD cohorts did not statistically differ with respect to age, gender, geographic region, type of health insurance, Charlson Comorbidity Index, or baseline measures of medical and prescription drug utilization. The relative risks of developing AMs in the AD and non-AD cohorts were estimated using competing risk-survival analysis. AM was defined by ICD-9-CM codes for asthma (493.xx), allergic rhinitis (477.xx), allergic conjunctivitis (372.05 or 372.14), and food allergy (693.1x, 692.5x, 995.60). The annual incremental cost attributable to AMs in these AD patients was calculated from medical claims with AM and AD diagnosis codes and from pharmacy claims for prescription drugs used to treat asthma, allergic rhinitis, allergic conjunctivitis, or food allergy, and 95% confidence intervals (CIs) were calculated using the bootstrap method.RESULTS: Patients with AD were significantly more likely to develop AMs than patients without AD (21.8% versus 16.9%, adjusted relative risk [RR] = 1.33, 95% CI, 1.28-1.38). Among AD patients who developed AMs, allergic rhinitis was the most frequent manifestation (66.3%), followed by asthma (24.8%), allergic conjunctivitis (7.6%), and food allergy (1.8%). The incidence and adjusted RRs of developing AM for AD patients versus comparison patients were 5.3% versus 4.5% for asthma (RR = 1.20, 95% CI, 1.12-1.29), 14.6% versus 11.2% for allergic rhinitis (RR = 1.35, 95% CI, 1.29-1.41), 1.6% versus 1.1% for allergic conjunctivitis (RR = 1.50, 95% CI, 1.31-1.72), and 0.3% versus 0.1% for food allergy (RR = 2.35, 95% CI, 1.66-3.32). The annual AD + AM treatment costs for patients with AD increased substantially after they developed AMs. The additional financial burden attributable to AMs was estimated to be $482 per year, an almost 1.5-fold increase compared with AD cost alone (from $338 before AM development to $820 afterward, P < 0.001), with approxima...

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Topical Calcineurin Inhibitors for Atopic Dermatitis

Qureshi¹,

Fischer²

2006

Arch Dermatol

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Cost of atopic dermatitis and eczema in the United States

Cited by 197 publications

References 14 publications

The Effect of Atopic Dermatitis on Total Burden of Illness and Quality of Life on Adults and Children in a Large Managed Care Organization

The Effect of Atopic Dermatitis on Total Burden of Illness and Quality of Life on Adults and Children in a Large Managed Care Organization

Economic Burden of Atopic Manifestations in Patients With Atopic Dermatitis - Analysis of Administrative Claims

Topical Calcineurin Inhibitors for Atopic Dermatitis

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