Substantial Cost Burden, Health Care Utilization Found in Patients With Severe Atopic Dermatitis

Patients with atopic dermatitis were associated with significant economic burden primarily driven by outpatient visits and pharmacy use, which increased with disease severity.

US patients with atopic dermatitis (AD) were associated with significant economic burden driven primarily by health care utilization, with an increased impact observed in those with severe disease. Results were published in Journal of Managed Care & Specialty Pharmacy.

Considered to be a pediatric disease, AD prevalence has trended upward in recent years, with an estimated 7% of US adults also affected. Researchers note that the economic impact of the disease has been shown in prior studies, but substantial gaps remain in understanding the effect that AD has on the lives of adults, particularly by disease severity.

“Updates are needed using more current data and measures of disease severity…A valid algorithm to define AD severity is still lacking,” said the study authors.

They conducted a real-world retrospective study to describe the health care resource utilization and associated costs in US adults with diagnosed AD, overall and by disease severity.

In the analysis, adults aged at least 18 years who received a clinical diagnosis of AD in a dermatology electronic medical record database between 2016 and 2018 and who had at least 6 months of continuous enrollment in medical and pharmacy benefits before and after the index date were included (N = 4784; mean [SD] age, 42.3 [15.2] years; mean disease duration, 68.3 [142.9] months; 64.7% female).

Participants were assessed for baseline AD severity closest to the index date, measured via the Physician Global Assessment (PGA) score, with inpatient and outpatient services, visits to specialists and the related seasonality, treatment use, and associated annual direct health care costs also reported using descriptive statistics.

Of the patient cohort, 626 (13.1%) patients had baseline PGA scores available, with more than half reporting moderate (40.6%) or severe (16.0%) disease and 43.5% exhibiting clear to mild disease. Baseline total body surface area (BSA) was additionally reported for 320 (6.7%) patients, in which 33.1% had BSA less than 10%, 13.4% had BSA greater than 50%, 86.6% had BSA of 50% or less, and 53.5% had BSA of 10% or more.

For each patient yearly, annual all-cause direct health care costs were $10,474, which were primarily driven by outpatient visits and pharmacy use. Compared with patients with clear to mild disease, more patients with severe AD reported at least 1 dermatology (73.0% vs 58.5%) and allergy/immunology office visit (16.0% vs 5.5%), as well as greater use of AD-related medications (90.0% vs 64.3%). Little seasonal variation in dermatology office visits was noted.

Notably, all-cause total annual costs in patients with severe disease were significantly higher than in patients with clear to mild disease ($23,242 vs $8,936; P = .0002). Emergency department (ED) and pharmacy costs per patient per year for those with severe AD were also significantly higher than for patients with clear to mild disease (ED: $600 vs $202; P = .0201; pharmacy: $16,186 vs $3,575; P = .0002).

The researchers concluded that additional studies are warranted to further evaluate indirect costs associated with AD.


Wang X, Boytsov NN, Gorritz M, Malatestinic WN, Goldblum OM, Wade RL. US health care utilization and costs in adult patients with atopic dermatitis by disease severity. J Manag Care Spec Pharm. 2022;28(1):69-77. doi:10.18553/jmcp.2022.28.1.69