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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.