Acta Dermato-Venereologica 99-9CompleteContent | Page 7
762
CLINICAL REPORT
Economic Burden of Adult Patients with Moderate to Severe Atopic
Dermatitis Indicated for Systemic Treatment
Lieneke F. M. ARIËNS 1 , Kirsten J. M. VAN NIMWEGEN 2 , Marjan SHAMS 3 , Digna T. DE BRUIN 1 , Jorien VAN DER SCHAFT 1 ,
Harmieke VAN OS-MEDENDORP 1# and Marjolein DE BRUIN WELLER 1#
Department of Dermatology and Allergology, University Medical Center Utrecht, 2 Pharmerit International, and 3 Sanofi & Sanofi Genzyme,
Amsterdam, The Netherlands
#
These authors contributed equally to this work.
1
Given the introduction of new therapies targeting spe-
cific immune pathways for atopic dermatitis (AD), in-
formation on the economic burden of AD patients is
needed. Direct costs (medication use and healthcare
resource utilization) and costs of productivity loss
were studied in 90 adult patients with AD indicated for
systemic treatment. Costs were calculated for patients
with controlled (Investigator Global Assessment (IGA)
0–2) and uncontrolled (IGA 3–5) disease at inclusion.
Mean (95% confidence interval (95% CI)) total direct
costs were €5,191 (€4,382–6,019) per patient per
year (PPY), €4,401 (€3,695–5,215) for patients with
controlled AD vs. €6,993 (€5,552–8,406), mean dif-
ference €2,593 (€820–4,282) (p=0.014) for patients
with uncontrolled AD. Costs of productivity loss were
€10,040 (€6,260–14,012) PPY for the total group,
€6,886 (€4,188–10,129) PPY for patients with control-
led AD vs. €13,702 (€6,124–22,996) for patients with
uncontrolled AD, mean difference €6,816 (–€1,638–
16,677; p=0.148). Total costs (direct costs+costs of
productivity loss) were €15,231 (€11,487–19,455)
PPY for the total group, €11,287 (€7,974–15,436) for
patients with controlled AD vs. €20,695 (€14,068–
34,564), mean difference €9,408 (–€119–19,964)
(p=0.077) for patients with uncontrolled AD. Patients
with AD using systemic immunosuppressive treatment
incur considerable direct costs and costs of producti-
vity loss.
Key words: atopic dermatitis; systemic treatment; health eco-
nomics.
Accepted May 9, 2019; E-published May 10, 2019
Acta Derm Venereol 2019; 99: 762–768.
Corr: Lieneke F. M. Ariëns, Department of Dermatology and Allergology,
Room G02.124, University Medical Center Utrecht, NL-3508 GA Utrecht,
The Netherlands. E-mail: [email protected]
A
topic dermatitis (AD) is a chronic, inflammatory
skin disease characterized by intense pruritus and
a relapsing and remitting course. With a prevalence of
4.4% among adults in the European Union, AD is one of
the most common skin diseases (1, 2). AD has a signi
ficant effect on the quality of life (QoL) of patients and
their families due to intense pruritus and resulting sleep
loss and concentration problems, and its psychosocial
impact (3, 4). In addition to the psychosocial burden, AD
also has a substantial economic burden caused by costs
doi: 10.2340/00015555-3212
Acta Derm Venereol 2019; 99: 762–768
SIGNIFICANCE
Given the introduction of new therapies targeting speci-
fic immune pathways for atopic dermatitis, information
on the economic burden of patients with atopic dermati-
tis is needed. In 90 adult patients with atopic dermatitis
indicated for systemic treatment, direct costs (including
medication use and healthcare resource utilization) and
costs due to reduced work productivity were calculated.
Total costs (including directs and costs of productivity loss)
were €15,231 per patient per year for the total group and
€20,695 for patients with uncontrolled disease vs. €11,287
for patients with controlled disease. Costs of productivity
loss had the larger impact on total costs. These data indi-
cate that patients with atopic dermatitis using systemic im-
munosuppressive treatment incur considerable direct costs
and costs of productivity loss.
directly related to treatment (direct costs) including inpa
tient and outpatient visits, diagnostic tests, transportation
costs and medication costs (5). Indirect costs, caused by
productivity losses also substantially contribute to the
economic burden (4).
Several studies have attempted to quantify the eco
nomic burden of AD. However, studies are often difficult
to compare as they have focused on variable costs in
specific patient populations and used different definitions
of direct and indirect costs (4–10). In addition, studies
were performed in various healthcare systems across
different countries and costs were based on claims or
patient-reported data leading to a high risk of recall bias.
A recent study using data from the 2013 US National
Health and Wellness Survey demonstrated that patients
with AD have significantly higher healthcare resource
utilization and direct costs compared with non-AD con
trols (6). Another study performed in the US showed
that patients with AD have a significantly higher work
absenteeism rate and activity impairment rate compared
with non-AD controls (4). This impact of AD on work
productivity and activity impairment may lead to sub
stantial indirect medical costs.
During the past decade, the increasing knowledge of
the underlying immune pathogenesis of AD has led to the
development of new therapies targeting specific immune
pathways (11). Dupilumab, a fully human monoclonal
antibody targeting the interleukin (IL)-4α receptor,
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.