Patients With Atopic Dermatitis Report Broad Array of OOP Expenses Related to Disease

In addition to significant morbidity and impaired health-related quality of life, patients with atopic dermatitis have a significant out-of-pocket (OOP) financial burden related to their disease.

In addition to significant morbidity and impaired health-related quality of life, atopic dermatitis (AD) is associated with considerable financial cost. More than 40% of US respondents to a survey reported that their annual AD out-of-pocket (OOP) expenses were $1000 or greater, according to a study published in Dermatitis.

In the United States, AD affects 13% of children and 7% of adults and is associated with profound itch, skin pain, sleep disruption, and mental health disturbances. Individuals with AD have more interaction with the health care system (ie, outpatient office visits, emergency department visits, and hospitalizations) compared with individuals without AD, and this utilization of health care resources results in substantial costs to the patient and their family.

“[OOP] expenses are particularly important in the day-to-day lives of AD patients and their families,” the authors wrote. “Although US population-based surveys demonstrated multifactorial increases in overall OOP health expenses related to AD, OOP costs are not well characterized from an individual perspective.”

Between November 14, 2019, and December 21, 2019, all members of the National Eczema Association, as well as 113,302 individuals with AD and nonaffected family members worldwide received a 25-question online survey. This study only looked at the responses from US adults. A total of 1118 respondents met the inclusion criteria.

More than half (57.7%) of the respondents had employer-sponsored insurance and a household income of at least $50,000 (61.7%). The majority said their AD was either moderate (47.5%) or severe (26.3%). The respondents’ disease was not well controlled: 23.2% said their AD was minimally controlled and 40.1% said their disease was somewhat controlled. Nearly half (48.8%) reported 3 or more health care provider visits in the past year to evaluate or manage their AD.

More than two-thirds (68.7%) reported that they had OOP expenses for copays and/deductibles in the past 30 days and nearly one-third (31.2%) spent more than $100. In addition, 33.9% reported spending more than $50 OOP for prescription medication co-pays covered by insurance. In addition, nearly half (48.6%) spent money on prescriptions not covered by their insurance.

A majority of respondents (57.5%) reported that they were currently using 3 or more prescription therapies. Only 10.4% reported no prescription therapies. Patients with more prescriptions were more likely to be White or Asian, have increased disease severity, reduced control, more monthly flare days, more health care provider visits, and allergic and infectious comorbidities.

Respondents also indicated that they often spent OOP on nonprescription products. For instance, 94.3% said they had purchased nonprescription moisturizers/emollients in the past month with 52.8% spending up to $50. Overall, the median annual OOP expense related to AD was $600, although these reported expenses ranged from $0 to as much as $200,000. While 42.0% of respondents reported they had spent more than $1000, 8.5% noted that they had spent more than $5000.

“Together, these results show a significant OOP financial burden for AD, reflecting the real-life efforts of patients to better manage their disease,” the authors wrote.

They cited the cross-sectional nature of the study and the inability to assess changes in cost, treatment, and health care utilization over time. Since the survey was conducted online, selection bias is also a possibility. However, they added that the large cohort distributed throughout the United States, as well as the use of 22 unique categories of OOP expenses, were strengths of the study.

“In conclusion, OOP expenses for individuals with AD are broad and occupy a number of unique health care categories,” the authors wrote. “Health care providers and patients should be cognizant of these costs and engage in shared decision making to create a treatment plan that minimizes financial burden.”


Smith Begolka W, Chovatiya R, Thibau IJ, Silverberg JI. Financial burden of atopic dermatitis out-of-pocket health care expenses in the United States. Dermatitis. Published online December 14, 2020. doi:10.1097/DER.0000000000000715