Caregiver OOP Costs in AD Higher for Pediatric vs Adult Patients


This study investigated the impact atopic dermatitis (AD) has on out-of-pocket (OOP) costs for caregivers of pediatric patients with the chronic skin condition.

New study findings illustrate the financial impact that atopic dermatitis (AD) can have among the caregivers of pediatric patients, especially with this patient population carrying its own unique and often increased out-of-pocket (OOP) expenses compared with older patients with the chronic skin condition, study authors wrote.

Findings published recently in Skin Health and Disease highlight the importance of maximizing care quality for pediatric patients living with AD while minimizing the OOP costs of their care as paid by their caregivers.

“Heterogeneity of AD, including variable skin manifestations, symptoms, severity, longitudinal course, and comorbidities, makes AD challenging to treat and burdensome for children, caregivers, and families,” the investigators wrote. “We hypothesized that children with AD had unique increases in various OOP expense categories and overall increased OOP expenses that were associated with increased measures of disease activity and severity.”

Of the original 113,502 members of the National Eczema Association who were sent an online survey between November and December 2019 that gauged their AD-related OOP costs, 1118 met the study inclusion criteria of being a US resident, being at least 18 years old, and a patient with AD or a primary caregiver for a child or adolescent living with AD. For this study, pediatric patients were classified as being younger than 18 years, and OOP expenses were measured in 4 areas:

  • Health-related categories: $0, $1-$50, $51-$100, $101-$150, $151-$200, $201-$250, $251-$275, $275-$300, and above $300
  • Self-reported OOP expenses for the past year
  • OOP expenses for the past month compared with average costs
  • Impact of OOP AD costs on everyday finances

Compared with an older patient population, pediatric patients in this study had higher rates of caregiver-reported food allergies (57.8% vs 33.6%), persistent skin infections (26.2% vs 17.1%), and 5 or more annual AD-related visits to their health care provider (29.7% vs 20.4%). There was also a sizeable difference in the rate of severe AD (32.5% vs 24.9%, respectively); however, caregivers also reported higher rates of moderately/very well controlled disease among pediatric vs adult patients (46.5% vs 33.3%).

In addition, caregivers of pediatric patients were likely to report fewer patients using any systemic treatment compared with older patients (34.6% vs 42.7%) but more patients using topical antimicrobials (29.0% vs 14.9%).

The following monthly health-spending–related categories saw more pediatric patient caregivers report OOP costs for vs older patient caregivers:

  • Hospitalization: 4.6% vs 1.9%
  • Emergency department visits: 17.7% vs 12.1%
  • Hygiene products: 91.1% vs 83.3%
  • Specialized cleaning products: 86.6% vs 71.6%
  • Specialized clothing/bedding: 62.0% vs 40.3%

Monthly OOP costs above $100 were also higher for pediatric vs adult caregivers for childcare, transportation, moisturizers, and specialized cleaning products, clothing, and bedding. More pediatric caregivers also reported higher average OOP costs within the past month compared with their average OOP expenses (50.4% vs 38.2%).

Similar findings were seen for yearly expenses, with caregivers of patients younger than 18 years reporting median yearly OOP costs of $860 (range, $10-$100,000) vs $500 (range, $0-$200,000) among adult patient caregivers; the former also more often reported yearly expenses of $1000 and above, at 48.9% vs 40.0%. Higher total OOP spend among pediatric caregivers was also linked to higher rates of moderate and severe cases of AD (45.3% vs 69.7%, respectively), compared with caregivers of adult patients (37.0% and 59.0%), and moderate, severe, and devastating financial effects vs adult caregivers (41.9%, 21.7%, and 5.9% vs 39.6%, 20.6%, and 3.2%).

The study investigators also found 2 predictors of harmful financial impact from AD-related OOP costs for pediatric patients. Their analyses showed that patients of a Black/African American race had a 2.86-times greater risk of financial harm (odds ratio [OR], 3.89; 95% CI, 1.66-8.98) and those whose caregivers’ annual OOP spend exceeded $1000, a 5.98-times greater risk (OR, 6.98; 95% CI, 3.46-14.08).

Speaking to their findings’ strengths, the authors note that their data echo previous results in the space that speak to the high disease burden associated with childhood AD, as well as highlight the large financial burden imposed by many treatments. Because of this, they urge health care practitioners to formulate flexible, fiscally responsible treatment plans “when managing nonmedicated approaches” and advocate for better health plan coverage “of basic, nonprescription therapies for children with AD to reduce the OOP financial burden related to these.”

They also recommend future studies in the space, “to design strategies to reduce OOP costs and improve outcomes in childhood AD.”


Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. The financial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States. Skin Health Dis. Published online November 30, 2022. doi:10.1002/ski2.191

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