The direct and indirect economic costs of chronic hand eczema (CHE) are comparable with other dermatological conditions. |
Ongoing development of new therapies means the direct economic burden of CHE may be higher than estimated in this literature review, since some of the included studies are more than 10 years old. |
There are few studies of the economic cost burden of absenteeism, presenteeism and job change in CHE. |
The societal costs of CHE are likely underestimated. |
1 Introduction
Economic costs—societal costs |
Direct costs |
Medical costs |
Prescribed treatment costs |
Hospital costs |
Other costs |
Non-medical costs |
Non-prescribed treatment costs |
Indirect costs |
Lost productivity costs |
Out-of-pocket costs |
Non-economic healthcare resource utilisation costs |
Hospitalisations |
Consultations |
Laboratory evaluation and treatments |
Work impairment and missed work time |
Absenteeism and presenteeism |
Job change |
2 Methods of the Review
2.1 Eligibility Criteria
2.2 Searches
2.3 Screening, Data Extraction and Quality Assessment
3 Results
3.1 Included Studies
3.2 Cost Studies
3.2.1 Direct Costs
References | Country | Cost | US$ (2020) | € (2020) |
---|---|---|---|---|
Cortesi et al. [15] | Italy | Mean per patient-month cost of pharmacological therapy (minimum–maximum) Mean per patient-month cost of non-pharmacological therapy, e.g. emollients, galenic formulations, and ultraviolet irradiation (minimum–maximum) | $28.34 ($0–$144.92) $29.21 ($0–$161.71) | €20.15 (€0–€103.04) €20.77 (€0–€114.98) |
Fowler et al. [16] | USA | Per patient monthly costs (mean ± SE) | ||
Prescription drugs Outpatient services | $165.02 (±$8.47) $255.71 (±$20.02) | €117.33 (±€6.02) €181.81 (±€14.23) | ||
NICE TA177 [12] | UK | Acquisition cost (per cycle of therapy) | ||
Alitretinoin Ciclosporin PUVA Azathioprine | $716.17 $307.16 $960.14 $31.34 | €509.20 €218.39 €682.66 €22.28 | ||
Refractory costs for alitretinoin, ciclosporin, PUVA, azathioprine (per 4 weeks) | $20.60 | €14.65 | ||
Supportive costs (per 4 weeks) | ||||
Alitretinoin Ciclosporin PUVA Azathioprine | $101.92 $99.88 $91.50 $95.22 | €72.47 €71.01 €65.06 €67.70 | ||
Remission costs (4 weeks) | ||||
Alitretinoin Ciclosporin PUVA Azathioprine | $9.70 $20.60 $20.60 $20.60 | €6.90 €14.65 €14.65 €14.65 | ||
Blank et al. [11] | Switzerland | Mean cost per month | ||
Alitretinoin (30 mg capsules) Emollients | $702.44 $36.49 | €499.43 €25.94 | ||
Average cost per month | ||||
Patients taking alitretinoin (30 mg) Patients taking placebo Patients clear or almost clear maintenance Severe non-responders | $797.72 $75.01 $46.63 $191.57 | €567.18 €53.33 €33.15 €136.21 | ||
Augustin et al. [14] | Germany | Yearly treatment costs | ||
Topical corticosteroids Emollients | $599.05 $178.40 | €425.92 €126.84 |
References | Country | Cost | US$ (2020) | € (2020) |
---|---|---|---|---|
Cortesi et al. [15] | Italy | Mean per patient-month cost of hospitalisation (minimum–maximum) | $105.04 ($0–$1425.97) | €74.68 (€0–€1013.86) |
Fowler et al. [16] | US | Mean per patient-month cost of inpatient services (±SE) | $81.86 (±$12.18) | €58.20 (±€8.66) |
Augustin et al. [14] | Germany | Yearly inpatient cost | $639.59 | €454.75 |
References | Country | Cost | US$ (2020) | € (2020) |
---|---|---|---|---|
Cortesi et al. [15] | Italy | Mean (minimum–maximum) per patient-month cost | ||
Medical consultation | $63.96 ($0–$627.03) | €45.48 (€0–€445.82) | ||
Diagnostic examinations | $30.51 ($0–$240.03) | €21.69 (€0–€170.66) | ||
Other products (or instruments, such as gloves or gauze bandages, vacuum cleaners, and cosmetic) | $42.37 ($0–$1460.22) | €30.13 (€0–€1038.22) | ||
Blank et al. [11] | Switzerland | Mean cost per month | ||
Pregnancy testing + oral contraceptives | $27.37 | €19.46 | ||
Dermatologist visits | $39.53 | €28.11 | ||
Lipid monitoring tests | $16.22 | €11.53 | ||
PUVA/311 nm (topical/oral) | $174.34 | €123.96 | ||
Topical corticosteroids total (assumption was that 25% of patients were treated with Class I–III and 75% were treated with Class IV topical corticosteroids) | $29.40 | €20.90 | ||
Topical corticosteroids Class I–III | $42.57 | €30.27 | ||
Topical corticosteroids Class IV | $25.34 | €18.02 | ||
van Gils et al. [13] | The Netherlands | Cost per consultation | ||
Dermatologist | $117.80 | €83.76 | ||
General practitioner | $45.82 | €32.58 | ||
Clinical occupational physician | $37.21 | €26.46 | ||
Specialized nurse | $97.44 | €69.28 | ||
Occupational physician | $37.21 | €26.46 | ||
Homeopath | $99.01 | €70.40 | ||
Internist | $117.80 | €83.76 | ||
Psychologist | $137.49 | €97.76 | ||
Light therapy | $77.03 | €54.77 | ||
Insurance physician | $70.45 | €50.09 | ||
Acupuncture | $73.34 | €52.14 | ||
Augustin et al. [14] | Germany | Yearly costs | ||
Outpatient care | $172.32 | €122.52 | ||
Diagnostics | $397.34 | €282.51 | ||
UV therapy | $457.14 | €325.03 |
3.2.2 Indirect Costs
3.2.3 Total Costs
References | Country | Cost | US$ (2020) | € (2020) |
---|---|---|---|---|
Cortesi et al. [15] | Italy | Mean total costs per patient-month (minimum–maximum) | $652.66 ($53.51–$3595.59) | €464.04 (€38.05–€2556.46) |
Fowler et al. [16] | USA | Total direct medical cost per month | $452.05 (SE $32.35) | €321.41 (SE €23.00) |
Diepgen et al. [17] | Germany | Total yearly costs | ||
SHI patients | $3440.26 | €2446.02 | ||
Direct medical costs | $2816.48 | €2002.52 | ||
Indirect costs | $623.77 | €443.50 | ||
OHI patients | $10,883.20 | €7737.96 | ||
Direct medical costs | $5349.57 | €3803.54 | ||
Indirect costs | $5532.17 | €3933.37 | ||
Non-working SHI patients | $2007.18 | €1427.10 | ||
Work-unaffected SHI patients | $2316.87 | €1647.29 | ||
Work-impaired SHI patients | $8142.67 | €5789.44 | ||
Direct costs | $5115.84 | €3637.36 | ||
Indirect costs | $3026.83 | €2152.08 | ||
Work disease OHI patients | $12,500.33 | €8887.73 | ||
Direct costs | $5349.57 | €3803.54 | ||
Indirect costs | $5532.17 | €3933.37 | ||
Augustin [14] | Germany | Total yearly societal cost per patient | $3440.26 | €2446.02 |
Direct costs | $2816.48 | €2002.52 | ||
Indirect costs | $623.77 | €443.50 | ||
van Gils [13] | The Netherlands | Mean (SD) cost per year per patient | ||
Integrated care—total societal costs | $5838.46 (1290.34) | €4151.15 (917.43) | ||
Direct costs | $1546.79 (129.74) | €1099.77 (92.25) | ||
Indirect costs | $4291.67 (1247.77) | €3051.38 (887.16) | ||
Usual care—total societal costs | $2549.26 (694.33) | €1812.52 (493.67) | ||
Direct costs | $775.42 (76.02) | €551.32 (54.05) | ||
Indirect costs | $1773.84 (659.87) | €1261.20 (469.17) |
3.3 Studies Reporting Resource Use
3.3.1 Hospitalisations
3.3.2 Consultations
References | Country | Consultations |
---|---|---|
Thyssen et al. [24] | Finland | > 5 visits (1982–83) Hand eczema: 34.5% Allergic contact dermatitis: 34.9% Irritant dermatitis: 11.9% |
Cortesi et al. [15] | Italy | Mean (minimum–maximum) number of specialist consultations (dermatologist, allergist, occupational physician, immunologist, police doctor) per patient-month: 0.9 (0.0–2.7) |
Augustin et al. [14] | Germany | Outpatient care visits in the last 4 weeks: 3.1 |
Apfelbacher et al. [32] | Germany | After inclusion in the CARPE registry, trend of visits in the past 12 months To the dermatologist: decreased strongly To the general practitioner: decreased strongly |
Blank et al. [11] | Switzerland | Dermatologist visits per month: 1 |
Malkonen et al. [30] | Finland | Consulted a doctor within the last 7 years: 48% |
Herschel et al. [19] | Germany | Mean number of physician visits in the past 12 months: 4.0 (SD 5.0) No GP visits in past 12 months: 22% GP care: 21.4% Dermatologist care: 74.9% |
Josefson et al. [28] | Sweden | GP visit: 50% (n = 129) |
Dibenedetti et al. [21] | USA | Time frame in which patients sought medical attention after noticing symptoms of CHE (n = 163) Within 6 months: 26% 6 months to 1 year: 34% Type of physician consulted for the first time Primary care physician: 54% Dermatologist: 39% |
Meding et al. [4] | Sweden | Visited a doctor (n = 868): 33% |
Hald et al. [22] | Denmark | Self-reported duration of hand eczema symptoms within the past 12 months in relation to medical consultations (n = 427) Not seen by a medical doctor (n = 138, missing data n = 1) All the time: 3.6% More than half the time: 8.0% Half the time: 5.8% Less than half the time: 63.0% No symptoms: 19.6% Seen by a GP but not a dermatologist (n = 102) All the time: 9.8% More than half the time: 12.7% Half the time: 9.8% Less than half the time: 45.1% No symptoms: 22.5% Seen by a GP and a dermatologist (n = 184, missing data n = 2) All the time: 16.8% More than half the time: 11.4% Half the time: 14.7% Less than half the time: 42.9% No symptoms: 14.1% |
Lerbaek et al. [29] | Denmark | (n = 188) 1 GP visit: 25.3% 2–5 visits: 22.6% > 5 visits: 15.6% Total visits (n = 186): 63.4% Multivariate model to predict >1 medical consultation Significant predictors, AD vs. no AD: OR 3.0 (95% CI 1.4–6.4), p = 0.006 |
Petersen et al. [23] | Denmark | Patients who have experienced periods of hand eczema since 2007 (n = 419) GP visit: 47% Dermatologist visit: 40% 1 GP visit: 23% > 5 GP visits: 6% 1 dermatologist visit: 14% > 5 dermatologist visits: 13% |
Steengaard et al. [31] | Denmark | (n = 144) Visits to dermatologist, total: 35.4% Intervention: 44.0% Control: 26.1%, p = 0.20 |
3.3.3 Laboratory Evaluation and Treatments
References | Country | Tests and treatments |
---|---|---|
Blank et al. [11] | Switzerland | Cost items, per month (used in a cost-effectiveness model) Alitretinoin 30 mg capsules: 28 × 30 mg (one capsule per day) Emollients: 200 g Pregnancy testing + oral contraceptives: 1 test, 21 tablets Lipid monitoring tests: 1 test PUVA/311 nm (topical/oral): 20 cycles per 10 weeks in a 6-month period (3.33 cycles per month) Topical corticosteroids: 60 g |
Augustin et al. [14] | Germany | Diagnostics tests in the last 4 weeks: 1.7 Emollient products in the last 4 weeks: 1.3 Topical corticosteroid products in the last 4 weeks: 1.1 UV therapy (including PUVA) sessions in the last 4 weeks: 8.6 |
Cortesi et al. [15] | Italy | Mean (minimum–maximum) tests and treatments per patient-month Number of diagnostic tests (patch test, prick test, RAST, PRIST, atopy patch test, skin biopsy, test for hives, and immunofluorescence): 0.6 (0.0–2.1) Number of UV: 4.0 (4.0–4.0) Number of emollients: 1.2 (0.5–5.4) Number of galenic products: 1.1 (0.5–2.1) Number of other therapies (e.g. detergents/soaps, antiseptics): 0.8 (0.5–2.1) |
Petersen et al. [23] | Denmark | Emollient use: 59% of patients Topical corticosteroid use: 64% of patients Systemic therapy: 7% of patients Phototherapy: 6% of patients |
3.3.4 Absenteeism and Presenteeism
References | Country | Work impairment and missed work time |
---|---|---|
Agner et al. [18] | Europe | People with hand eczema and subdiagnoses of atopic eczema and allergic contact dermatitis were associated with increased frequency of sick leave: 0.122 (p = 0.023) and 0.128 (p = 0.032), respectively |
Apfelbacher et al. [25] | Germany | Currently unable to work: 21.6% Sick leave in the past 12 months (all patients): 32.7% |
Apfelbacher et al. [38] | Germany | Sick leave in past 12 months > 0–2 weeks: 48.6% > 2–6 weeks: 30.5% > 6 weeks: 20.9% |
Apfelbacher et al. [32] | Germany | Changed or given up their job because of CHE: 5.4% Sick leave (in the past 12 months): 35.3% Currently unable to work (at baseline): 24.5% |
Augustin et al. [14] | Germany | Sick leave in the last year: 33% Average number of days sick leave per year: 7.2 days |
Cazzanniga et al. [20] | Germany and Switzerland | CHE in workers in food-handling jobs was strongly associated with the ability to work and sick leave In men, there was a strong association with long duration of hand eczema (> 6 years) and job loss or change |
Diepgen et al. [17] | Germany | Patients in employment who had sick leave in the last 12 months: 42% Mean number of days of sick leave: 35 days |
Diepgen et al. [39] | Germany | Sick leave due to hand eczema: 28.4% Sick leave for more than 5 consecutive weeks: 12.3% |
Herschel et al. [19] | Germany | Unable to work: 24.7% Changed jobs due to disease: 12.6% |
Thyssen et al. [24] | Finland | At least 7 days off sick: 6% Change in job due to hand eczema: 3% Receiving sickness pension because of the illness: 2% |
Malkonen et al. [30] | Finland | Sick leave in the past 7 years because of hand eczema: 23% Sick leave was associated with age (45 years or older) at the time of diagnosis, but not with sex, diagnosis, atopy, occupation or specific work-related allergies Job loss (unemployment and retirement) due to occupational hand eczema: 25% of patients (most frequent among patients aged 45 years or older, in patients with allergic contact dermatitis, or in food-related occupations) |
Fowler et al. [16] | USA | Mean percentage of work time missed: 4.08% (SE ± 11.03) Mean percentage of impairment while working: 26.86% (SE ± 31.39) Percentage of overall work impairment: 29.33% (SE ± 31.73) |
Dibenedetti et al. [21] | USA | Missed work or school activities over the previous 3 months: 24% In patients who missed work or school over the previous 3 months: mean days missed: 4.4 (SD 3.3) Changed jobs or left job due to CHE: 4% Short-term disability due to CHE: 6% (3% had applied for workers’ compensation) |
Josefson et al. [28] | Sweden | Changed job due to hand eczema: 15.5% of women with hand eczema |
Meding et al. [4] | Sweden | Median total sick leave time: 38 weeks (range 1–312) At least 7 days (since 1983): 6% |
Agner [33] | Denmark | Within the past 5 years Changed profession or were no longer working: 51% Changed profession: 32.6% Outside the labour market: 18.8% (NB: this is not necessarily due to hand eczema) Participants who reported being ‘clear’ (with regard to hand eczema healing) Changed profession or left the labour market: OR 1.62 (95% CI 1.06–2.47) Stayed in the same profession: OR 2.85 (95% CI 1.83–4.24) [difference is significant] More participants who changed profession or left their profession reported improvement in their hand eczema compared with those who stayed in the same profession: OR 1.91 (95% CI 1.44–2.54) and 1.51 (95% CI 1.09–2.10), respectively Change of profession and being outside the labour market did not significantly influence the number of severe cases at 4- to 5-year follow-up: OR 0.75 (95% CI 0.37–1.55) and 1.61 (95% CI 0.83–3.12), respectively |
Cvetkovski et al. [27] | Denmark | Sick leave due to occupational hand eczema in the past 12 months: 57% Job loss in the past 12 months: 22.9% More than 5 weeks per year of sick leave (prolonged sick leave): 19.9% Women had more prolonged sick leave than men in all age groups except the oldest group (50 + years) Prolonged sick leave Severe occupational hand eczema: 30% Either moderate or minimal occupational hand eczema: 17.6% |
Cvetkovski et al. [46] | Denmark | Multivariate analysis predicting sick leave after 1-year follow-up for workers with occupational hand eczema Significant predictors: aged 40–49 years compared with aged 18–24 years (RR 5.28, 95% CI 1.4–20.7); severe symptoms compared with no/minimal symptoms (RR 5.29, 95% CI 1.6–17.7); previous long-term sick leave compared with no previous long-term sick leave (RR 5.20, 95% CI 2.0–13.6); low quality of life compared with high quality of life (RR 4.62, 95% CI 1.6–13.7) Non-significant predictors (p-values NR): sex, socioeconomic status, subdiagnosis, AD, duration of eczema, occupation, depression |
Hald et al. [22] | Denmark | CHE (i.e. patients with symptoms about half the time or more, or continuous symptoms the preceding year) Sick leave within the past 12 months: 1% Mean duration of sick leave: 6 days |
Lerbaek et al. [29] | Denmark | Changed jobs: 8.5% Sick leave < 1 week: 2.2% 1–2 weeks: 4.3% 3–5 weeks: 2.7% > 6 weeks: 3.2% Total patients reporting sick leave: 12.4% Multivariate predictors of sick leave ever Marginally significant predictors: AD yes vs. no: OR 2.9 (95% CI 1.0–8.1), p = 0.05); socioeconomic status (0.05) Non-significant predictors: sex (p = 0.28); zygosity of twins (p = 0.84); age of onset (0.54); positive patch test (p = 0.52) |
Hald et al. [40] | Denmark | Patients reporting sick leave at baseline: 9.4% 6-month follow-up (after seeing a dermatologist): 4.1% |
Mollerup et al. [41] | Denmark | Sick leave within the last 12 months Women: 24.5% Men: 10.7% |
Petersen et al. [23] | Denmark | Sick leave: 8% – most common in women (p = 0.007) and associated with severity of hand eczema at baseline (p = 0.029) and eczema on body locations other than the hands (p = 0.005) Job loss: 5% |
Steengaard et al. [31] | Denmark | Sick leave in hairdressing-school participants Intervention (selected teachers underwent a 2-day course in general skin physiology and prevention of hand eczema and allergy): 16.0% Control (traditional training): 8.7%, p = 0.3 Those who left their jobs who reported hand eczema as the reason for leaving: 12.5% |
van der Meer et al. [36] | The Netherlands | Absenteeism A survey of 1178 healthcare professionals revealed that 403 took sick leave. Of those who took sick leave, 1.0% (n = 4) was due to hand eczema, for an overall prevalence of 0.3% (n = 2) [0.1–0.9%] 3-month prevalence of hand eczema: 1.7% (n = 2) [0.4–6.5%] Presenteeism: healthcare professionals for the past 3 months (n = 116) (CI) Went to work at least 1 day while having hand eczema: 84% (76–89%) Went to work >30 days while having hand eczema: 22% (13–34%) Went to work on >60 days while having hand eczema: 1.7% (0.4–6.6%) Presenteeism: amount of work performed on work days with HE (scale of 0–10 where 0 is 'could not work' and 10 is 'same as usual') (n = 98) Mean: 9.4 (SE 0.1) Median: 10 Score ≤ 5: 3.4% (CI 1.4–8.0%) Score ≤ 9: 25% (CI 18–32%) Presenteeism: quality of work performed on work days with hand eczema (scale of 0 to 10 where 0 is 'worst quality' and 10 is 'same quality as usual') (n = 98) Mean: 9.5 (SE 0.1) Median: 10 Score ≤ 5: 2.1% (CI 0.7–6.2%) Score ≤ 9: 26% (CI 17–37%) |