The Economic and Psychosocial Comorbidity Burden Among Adults with Moderate-to-Severe Atopic Dermatitis in Europe: Analysis of a Cross-Sectional Survey

Abstract

Introduction Atopic dermatitis (AD) is a common inflammatory disease of the skin, which may have a substantial impact on patients' health-related quality of life (HRQoL). The aim of this study was to quantify the economic burden (direct and indirect costs) of moderate-to-severe AD and evaluate the prevalence and impact of psychosocial comorbidities among patients in the European Union-5 (France, Germany, Italy, Spain, and the UK). Methods Data were analyzed from the 2017 EU5 National Health and Wellness Survey. Respondents with a physician diagnosis of AD/eczema who were considered to have moderate-to-severe AD based on a Dermatology Life Quality Index (DLQI) score ≥ 6 were included. Direct costs, indirect costs, and psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) were reported descriptively. Generalized linear models were used to examine the relationship between psychosocial comorbidities and health outcomes (the Short Form-36 version 2 [SF-36v2], EuroQoL 5-dimension 5-level, Work Productivity and Activity Impairment questionnaire, and healthcare resource utilization). Results Overall, 1014 patients were included in the analysis. Total annual direct costs ranged from €2242 to €6924 and total annual indirect costs ranged from €7277 to €14,236, depending on the level of disease severity. Sleep difficulties, anxiety, and depression were reported by 61.6%, 52.7%, and 75.8% of patients, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores from SF-36v2 and increased overall work impairment ( p < 0.05 for all). Conclusions A significant economic burden was observed for patients with moderate-to-severe AD. Sleep difficulties, depression, and anxiety were observed in more than half of moderate-to-severe AD patients and were significantly associated with decrements in HRQoL and with work-related impairment. Reducing the burden of these psychosocial comorbidities in AD could have significant benefit to patients and society.

Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case–Control Study

“…Based on the assumption that AD patients treated with very potent TCS had at least moderate disease, this analysis showed that more severe AD is possibly associated with a greater economic burden of comorbidities compared to milder AD. These findings are consistent with the conclusions from previous studies where increased disease severity was shown to be associated with a substantial increase in the frequency of comorbidities, which further associate with detrimental impact on quality of life and productivity loss [ 27 , 63 ]. This notion would support the hypothesis that early diagnosis and treatment of mild-to-moderate AD may prevent the future development of associated comorbidities, which represent a significant burden to the health service [ 64 ].…”

“…Additionally, studies have shown that early AD treatment is essential in treating this skin disease, and may also delay or prevent the atopic march [ 23 ]. The literature has also demonstrated the negative impact of AD and the associated comorbidities on patients’ quality of life [ 24 – 27 ] and on work productivity [ 27 , 28 ]. Additionally, AD patients have a higher economic burden compared with non-AD patients and, further, increasing disease severity is correlated with substantially higher healthcare resource utilisation (HCRU) and costs [ 27 , 29 ].…”

Inadequate Disease Control, Treatment Dissatisfaction, and Quality-of-Life Impairments Among US Patients Receiving Topical Therapy for Atopic Dermatitis

“…Furthermore, in a study of children aged 5-15 years with chronic skin diseases, those with AD showed greater QoL impairment from both the patient and caregiver's perspective compared with several other diseases, including acne, alopecia, and urticaria [11]. Additionally, in patient surveys conducted in the USA and Europe, adults with AD attributed a substantial impairment in work productivity to their AD [9,28], with worse impairment associated with higher DLQI scores [28]. The present study similarly showed deficits across work productivity and QoL domains in patients receiving standard-of-care topical therapy, alone or in combination with systemic therapy, with the most pronounced impairments observed among those with uncontrolled disease.…”

Patient and caregiver preferences on treatment attributes for atopic dermatitis

“…lost work productivity and impacts on quality of life) (4). The total annual indirect costs of moderate-to-severe AD for patients in France, Germany, Italy, Spain, and the United Kingdom (UK) has been estimated at e7277-e14,236 per patient, depending on the level of disease severity (10).…”