Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition. Patients with moderate/severe AD
have increased levels of itch, pain, sleep disturbance, anxiety and depression, and impaired health-related quality of life; the disease carries a substantial economic burden.
However, comprehensive data on the disease and its economic burden relative to the general adult population and other chronic skin disorders are limited.
A new study in the January 2018 issue of the Journal of the American Academy of Dermatology
evaluated these burdens, in terms of comorbidities, healthcare resource utilization (HCRU), and costs.
The study compared adults with AD with both adults without AD and adults with psoriasis. Both AD and psoriasis were classified as mild, moderate or severe. An additional aim of the study was to evaluate the impact of AD severity on these outcomes.
Patients with AD had a significantly greater risk for additional atopic, or allergic, diseases, as well as significantly greater HCRU and total cost compared with non-AD controls. The burden of AD was generally comparable to that of psoriasis, although patients with AD reported increased use of emergency room (ER) visits compared with patients with psoriasis.
The study used data from the 2013 National Health and Wellness Survey (NHWS). The NHWS is an Internet-based survey that is nationally representative of the US adult population. Out of 1,183,287 individuals asked to complete the survey, 109,592 (9.3%) responded and of those, 75,000 (68.4%) were included.
Researchers used the Charlson Comorbidity Index (CCI) to evaluate the overall comorbidity burden. Respondents were asked:
- “Which of the following conditions have you experienced in the past 12 months?” or
- “Which of the following conditions have you ever experienced” and
- “Has your condition been diagnosed by a physician?”
Respondents were asked to self-report about:
- Arthritis (including osteoarthritis, rheumatoid arthritis, and psoriatic arthritis)
- Atopic-related comorbidities (asthma and hay fever/nasal allergies)
- High cholesterol level
Compared with non-AD controls, patients with AD had a significantly increased risk for arthritis (odds ratio [OR], 1.7; 95% CI, 1.3-2.3; P
< .001), asthma (OR, 3.3; 95% CI, 2.3-4.7; P
< .001), and nasal allergies/hay fever (OR, 2.9; 95% CI, 2.2-3.8; P
The risk for comorbidities in patients with moderate/severe AD was numerically higher, although not statistically significant compared with patients with mild AD.
HCRU was defined by the number of visits to a healthcare provider, emergency room or hospitalizations in the past 6 months.
Compared with non-AD controls, patients with AD reported using significantly more healthcare resources. Mean (SD) healthcare provider visits were 6.6 (9.8) versus 3.9 (5.4) (P
<.001). The number of ER visits and hospitalizations was more than twice that in non-AD controls.
In patients with AD, the mean (SD) number of ER visits was 0.5 (1.2) versus 0.2 (0.8) (P
<.001) and the mean (SD) number of hospitalizations was 0.3 (1.0) versus 0.1 (0.7) (P
Patients with moderate/severe AD used numerically greater resources than patients with mild AD; however, none of the differences were statistically significant.
Direct costs were estimated using data stratified according to age from the Medical Expenditure Panel Survey 2012. For each respondent, the number of each type of visit in the last 6 months was multiplied by 2 to extrapolate to the annual number of visits and then multiplied by its average cost.
Patients with AD incurred significantly higher costs than non-AD controls. Total mean (SD) annual per patient direct costs in patients with AD were $9782 higher than those of non-AD controls: $24,401 ($37,355) versus $14,619 ($29,799) (P
<.001). Controlling for the presence of asthma and nasal allergies/hay fever reduced the difference between AD and non-AD in total mean direct costs to $7901 (P
Patients with moderate/severe AD incurred numerically higher costs than did patients with mild AD across the evaluated categories. Controlling for the presence of asthma and nasal allergies/hay fever increased the difference between moderate/severe versus mild AD in total mean direct costs from $3757 to $5522. None of the differences were statistically significant.
Compared with patients with psoriasis, patients with AD had significantly higher odds of reporting asthma (OR, 1.7; 95% CI, 1.1-2.7; P
= .01) and nasal allergies/hay fever (OR, 2.3; 95% CI, 1.6-3.2; P
<.001). However, patients with psoriasis had higher odds of developing hypertension (OR, 0.7; 95% CI, 0.5-1.0; P
This analysis of comorbidities, HCRU, and costs shows that patients with AD have a significantly increased risk for reporting atopic diseases such as asthma and nasal allergies/hay fever compared with adults without AD.
The association between AD and allergic conditions such as asthma and allergies is already recognized and in line with the “atopic march” progression from AD to other common allergic conditions.
HCRU was significantly higher in the AD group across all categories, driven by healthcare provider visits and associated costs.
Although the numbers of reported hospitalizations and ER visits were small, the utilization of these categories by patients with AD was approximately twice that reported by non-AD controls. Overall, mean annual per patient total direct costs in patients with AD were approximately $10,000 higher than those of non-AD controls ($24,401 vs $14,619). Controlling for the presence of asthma and nasal allergies/hay fever reduced the AD versus non-AD difference in total mean direct costs by approximately 20%, which is in line with the higher atopic burden in patients with AD.
The study showed that adult patients with AD experience a substantial patient burden relative to matched controls without AD, as is evidenced by a significantly increased risk for development of atopic conditions (asthma and hay fever/nasal allergies) and arthritis, as well as increased HCRU and associated costs.
Adult patients with AD reported a significantly higher prevalence of atopic conditions and a significantly increased number of ER visits and associated costs relative to matched patients with psoriasis, whereas psoriasis was associated with a greater prevalence of hypertension.
Taken together, these data suggest a significant need for enhanced treatment options for patients with AD.
This study was limited by self-reported data, which is susceptible to recall bias and erroneous classification.
Eckert, L, Gupta S, Amand, C. The burden of atopic dermatitis in US adults: Health care resource utilization data from the 2013 National Health and Wellness Survey. Published online October 7, 2017. J Am Acad Dermatol. doi.org/10.1016/j.jaad.2017.08.002