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CLINICAL REPORT 263 Out-of-pocket Costs for Individuals with Atopic Eczema: A Cross- sectional Study in Nine European Countries Alexander ZINK 1 , Bernd ARENTS 2 , Antje FINK-WAGNER 2 , Irmtraud A. SEITZ 3 , Ute MENSING 3 , Niels WETTEMANN 3 , Giuseppe DE CARLO 2 and Johannes RING 1 Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany, 2 European Federation of Allergy and Airway Disease Patient’s Associations, Brussels, Belgium, and 3 IMAS International, Munich, Germany 1 Atopic eczema is one of the most common non-com- municable inflammatory skin diseases, and has a huge socioeconomic impact. Studies on the everyday eco- nomic impact of atopic eczema on patients, however, are limited. To estimate the annual extra out-of-pocket spending due to atopic eczema among patients in Eu- rope, a cross-sectional study using computer-assisted phone interviewing of patients with atopic eczema was performed in 9 European countries. A total of 1,189 patients (56% women) with atopic eczema, who were either eligible for, or on, systemic treatment, partici- pated in the study between October 2017 and March 2018. Mean extra spending on everyday necessities was €927 per patient per year for healthcare expen- ses, and this figure was slightly, but not statistically significantly, influenced by the severity of atopic ecze- ma. Emollients and moisturizers accounted for the hig- hest monthly costs, followed by medication that was not reimbursed, doctors’ and hospital costs. Atopic eczema-related out-of-pocket costs pose a substan- tial burden for affected individuals, are higher than in other chronic diseases, and should always be included in economic assessments of the impact of this disease. Key words: atopic eczema; atopic dermatitis; economic impact; out-of-pocket costs. SIGNIFICANCE Atopic eczema is a skin disease with a huge impact on the everyday lives of affected patients’ and their families, but little awareness in the general population. This study inclu- ding 1,189 people with atopic eczema living in 9 Euro­pean countries found that extra out-of-pocket spending due to the atopic eczema is another setback with a mean amount of €927 spent by every patient per year. Out-of-pocket costs are a substantial burden in atopic eczema and much higher than in other chronic diseases. These costs should always be taken into account in individual as well as econo- mic assessments of the disease. as well as overall out-of-pocket payment per month for AE-related healthcare aspects can have a huge financial impact. With new insights into the pathogenesis of AE (9–11) and an increase in new treatment strategies and biologicals (12–16), the real-life economic impact of AE is gaining importance. The aim of this large European study was to assess this economic impact and, in parti- cular, the out-of-pocket extra expenses due to AE in the daily life of affected individuals. Accepted Dec 6, 2018; E-published Dec 6, 2018 METHODS Acta Derm Venereol 2019; 99: 263–267. This cross-sectional study was conducted by telephone to ensure nationwide coverage, using computer-assisted telephone inter- viewing (CATI) in 9 large European countries (Czech Republic, Denmark, France, Germany, Italy, the Netherlands, Spain, Swe- den and the UK). Individuals with AE who were candidates for systemic treatment or phototherapy or who were currently on systemic treatment or phototherapy were eligible for participa- tion. Therefore, most of the study participants had initially had moderate-to-severe AE. Recruitment was based on physician referral (dermatologists, allergologists and general practitioners (GPs)) in all countries, whereas additional and alternative chan- nels were also used in Denmark, Sweden, the Netherlands and the Czech Republic, e.g. via support groups or recommendation, in accordance with national regulations. To assess the economic burden, items were derived from validated questionnaires, tested for comprehension and practicability as well as for consistency, and then finalized after extensive discussion with experts. Participants were asked “Can you estimate how many days in a year you have missed work or study because of your atopic eczema? This could be because of visiting a doctor, not feeling well or anything else related to your eczema” and “Can you estimate how much money you have to pay out of your pocket per month on average for the following healthcare aspects for your atopic eczema, because these medical treatments are not (completely) reimbursed by a Corr: Johannes Ring, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, DE-80802 Munich, Germany. E-mail: [email protected] A topic eczema (AE, atopic dermatitis) is one of the most common non-communicable inflammatory skin diseases. It affects 1–3% of the adult population in Europe (1–3). The chronic or relapsing nature of AE, with itch as the predominant symptom, can have a huge impact on affected individuals (4). Several studies have shown that physical wellbeing and quality of life can be severely impaired, especially in patients with severe AE (5–8). However, to date, the impact and intensity of symptoms in the daily life of individuals with AE have gained limi- ted attention. In particular, the economic implications of AE, including both the individual burden and the impact on the overall economy, have not been studied. Days mis- sed at work due to AE, disease-related extra spending in different areas, such as clothing and cleaning products, This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3102 Acta Derm Venereol 2019; 99: 263–267