Why carry out this study?
|
Atopic dermatitis (AD) is associated with a significant direct and indirect economic burden, and comorbidities associated with the disease can lead to poor health status, health-related quality of life (HRQoL), and work productivity. |
Data on the overall costs, prevalence, and impact of psychosocial comorbidities of AD among European patients are limited. |
This analysis quantified the economic impact (direct and indirect costs) and evaluated the prevalence and impact of psychosocial comorbidities (sleep difficulties, anxiety, and depression) in adult patients with moderate-to-severe AD in the European Union-5 (EU5) using data from the 2017 National Health and Wellness Survey. |
What was learned from the study?
|
Moderate-to-severe AD resulted in significant indirect (up to €14,000 per patient per year) and direct (up to €7000 per patient per year) costs across the EU5. |
Sleep difficulties, depression, and anxiety were observed in more than half of patients with moderate-to-severe AD and were significantly associated with decrements in HRQoL and work-related impairment. |
Digital Features
Introduction
Methods
Data Source
Sample
Measures
Demographics and Health History
Psychosocial Comorbidities
Health Outcomes
Statistical Analyses
Results
Sample Characteristics and Prevalence of Psychosocial Comorbidities
Moderate effect (DLQI 6–10) (N = 597) | Very large effect (DLQI 11–20) (N = 348) | Extremely large effect (DLQI 21–30) (N = 69) | p value | |
---|---|---|---|---|
Age, mean (SD) | 42.3 (16.3) | 40.3 (14.2) | 39.7 (13.5) | < 0.0001 |
Female [n (%)] | 430 (72.0) | 235 (67.5) | 37 (53.6) | < 0.0001 |
Country [n (%)] | ||||
France | 157 (26.3) | 82 (23.6) | 17 (24.6) | < 0.0001 |
Germany | 98 (16.4) | 68 (19.5) | 17 (24.6) | |
UK | 177 (29.7) | 83 (23.9) | 23 (33.3) | |
Italy | 87 (14.6) | 64 (18.4) | 9 (13.0) | |
Spain | 78 (13.1) | 51 (14.7) | 3 (4.4) | |
Married/living with partner [n (%)] | 335 (56.1) | 193 (55.5) | 49 (71.0) | 0.0432 |
University educated [n (%)] | 276 (46.2) | 168 (48.3) | 37 (53.6) | 0.0845 |
Currently employed [n (%)] | 341 (57.1) | 217 (62.4) | 49 (71.0) | 0.0008 |
Body mass index [n (%)] | ||||
< 18.5 (underweight) | 43 (7.2) | 16 (4.6) | 6 (8.7) | <0.0001 |
18.5 to < 25 (normal weight) | 238 (39.9) | 146 (42.0) | 23 (33.3) | |
25 to < 30 (overweight) | 145 (24.3) | 91 (26.2) | 14 (20.3) | |
≥ 30 (obese) | 126 (21.1) | 79 (22.7) | 24 (34.8) | |
Missing/unknown | 45 (7.5) | 16 (4.6) | 2 (2.9) | |
Smoking status [n (%)] | ||||
Currently smoke | 189 (31.7) | 110 (31.6) | 30 (43.5) | < 0.0001 |
Former smoker | 146 (24.5) | 89 (25.6) | 14 (20.3) | |
Never smoked | 262 (43.9) | 149 (42.8) | 25 (36.2) | |
Alcohol consumption [n (%)] | ||||
Currently drink | 470 (78.7) | 258 (74.1) | 51 (73.9) | 0.1979 |
Do not currently drink | 127 (21.3) | 90 (25.9) | 18 (26.1) | |
Charlson comorbidity index [n (%)] | ||||
0 | 470 (78.7) | 275 (79.0) | 39 (56.5) | < 0.0001 |
1 | 69 (11.6) | 35 (10.1) | 18 (26.1) | |
2 | 32 (5.4) | 20 (5.8) | 4 (5.8) | |
≥ 3 | 26 (4.4) | 18 (5.2) | 8 (11.6) | |
Other atopic condition [n (%)] | ||||
Allergic rhinitis and/or asthma | 234 (39.2) | 148 (42.5) | 35 (50.7) | 0.0057 |
Neither allergic rhinitis nor asthma | 363 (60.8) | 200 (57.5) | 34 (49.3) | |
Years since diagnosis of atopic dermatitis | ||||
< 5 years | 197 (33.0) | 142 (40.8) | 19 (27.5) | < 0.0001 |
6–10 years | 89 (14.9) | 50 (14.4) | 13 (18.8) | |
11–15 years | 63 (10.6) | 22 (6.3) | 8 (11.6) | |
≥ 16 years | 222 (37.2) | 111 (31.9) | 25 (36.2) | |
Missing/unknown | 26 (4.4) | 23 (6.6) | 4 (5.8) |
Overall Economic Burden
Moderate effect (DLQI 6–10) | Very large effect (DLQI 11–20) | Extremely large effect (DLQI 21–30) | p value | |
---|---|---|---|---|
France | ||||
Number of patients | 157 | 82 | 17 | |
Number employed | 83 | 43 | 9 | |
Mean (SD) | Mean (SD) | Mean (SD) | p value | |
Absenteeism % (WPAI-GH) | 11.2 (25.0) | 17.4 (27.0) | 20.3 (19.5) | 0.3146 |
Presenteeism % (WPAI-GH) | 31.1 (25.0) | 42.4 (28.0) | 63.3 (26.0) | 0.0008 |
Overall work impairment % (WPAI-GH) | 33.6 (27.7) | 47.9 (31.0) | 69.0 (27.8) | 0.0005 |
Healthcare provider visits | 7.85 (8.00) | 8.11 (10.11) | 9.76 (7.81) | 0.6911 |
Emergency room visits | 0.50 (1.29) | 0.73 (1.77) | 1.88 (2.71) | 0.0028 |
Hospitalizations | 0.27 (0.59) | 0.41 (0.92) | 0.65 (1.41) | 0.0964 |
Germany | ||||
Number of patients | 98 | 68 | 17 | |
Number employed | 49 | 38 | 9 | |
Mean (SD) | Mean (SD) | Mean (SD) | p value | |
Absenteeism % (WPAI-GH) | 22.4 (32.6) | 29.0 (35.7) | 38.3 (21.6) | 0.3517 |
Presenteeism % (WPAI-GH) | 34.8 (26.1) | 42.4 (25.9) | 41.0 (28.9) | 0.4239 |
Overall work impairment % (WPAI-GH) | 40.4 (30.2) | 52.1 (28.9) | 64.4 (27.7) | 0.0453 |
Healthcare provider visits | 11.62 (9.75) | 11.34 (11.15) | 13.47 (12.75) | 0.7559 |
Emergency room visits | 0.28 (0.74) | 0.34 (0.66) | 0.88 (1.32) | 0.014 |
Hospitalizations | 0.28 (0.74) | 0.34 (0.87) | 1.12 (1.41) | 0.0013 |
Italy | ||||
Number of patients | 87 | 64 | 9 | |
Number employed | 56 | 43 | 8 | |
Mean (SD) | Mean (SD) | Mean (SD) | p value | |
Absenteeism % (WPAI-GH) | 14.2 (25.7) | 14.0 (19.7) | 17.6 (19.2) | 0.9178 |
Presenteeism % (WPAI-GH) | 39.6 (26.6) | 43.3 (25.6) | 70.0 (12.0) | 0.0088 |
Overall work impairment % (WPAI-GH) | 42.5 (29.3) | 47.5 (27.9) | 74.0 (13.2) | 0.0141 |
Healthcare provider visits | 9.41 (14.59) | 8.11 (12.78) | 11.11 (9.24) | 0.7536 |
Emergency room visits | 0.24 (0.55) | 0.47 (0.84) | 1.44 (1.51) | <.0001 |
Hospitalizations | 0.08 (0.27) | 0.19 (0.50) | 0.78 (1.09) | <.0001 |
Spain | ||||
Number of patients | 78 | 51 | 3 | |
Number employed | 45 | 35 | 1 | |
Mean (SD) | Mean (SD) | Mean (SD) | p value | |
Absenteeism % (WPAI-GH) | 7.3 (11.8) | 15.3 (18.9) | 9.0 (-) | 0.0746 |
Presenteeism % (WPAI-GH) | 43.5 (28.3) | 53.1 (24.2) | 70.0 (-) | 0.1972 |
Overall work impairment % (WPAI-GH) | 47.3 (28.9) | 58.9 (26.2) | 72.0 (-) | 0.1453 |
Healthcare provider visits | 7.08 (5.95) | 9.75 (7.22) | 9.00 (6.00) | 0.0746 |
Emergency room visits | 0.65 (1.07) | 1.39 (1.42) | 0.33 (0.58) | 0.0029 |
Hospitalizations | 0.09 (0.51) | 0.47 (0.86) | 0.00 (0.00) | 0.0065 |
UK | ||||
Number of patients | 177 | 83 | 23 | |
Number employed | 86 | 51 | 18 | |
Mean (SD) | Mean (SD) | Mean (SD) | p value | |
Absenteeism % (WPAI-GH) | 10.9 (25.4) | 14.9 (26.3) | 23.9 (25.2) | 0.1374 |
Presenteeism % (WPAI-GH) | 29.5 (26.2) | 28.5 (28.0) | 60.6 (25.1) | <.0001 |
Overall work impairment % (WPAI-GH) | 32.3 (28.6) | 33.2 (31.5) | 67.9 (21.2) | <.0001 |
Healthcare provider visits | 6.55 (7.78) | 6.18 (11.26) | 5.87 (7.01) | 0.9118 |
Emergency room visits | 0.25 (0.73) | 0.47 (0.98) | 1.00 (1.76) | 0.0009 |
Hospitalizations | 0.21 (0.68) | 0.18 (0.57) | 0.87 (1.52) | 0.0003 |
Prevalence and Impact of Psychosocial Comorbidities
n (%) | France (N = 256) | Germany (N = 183) | Italy (N = 160) | Spain (N = 132) | UK (N = 283) | Total EU5 (N = 1014) |
---|---|---|---|---|---|---|
Severity of sleep difficulties | ||||||
No sleep difficulties | 90 (35.2) | 57 (31.1) | 76 (47.5) | 46 (34.8) | 120 (42.4) | 389 (38.4) |
Mild | 59 (23.0) | 53 (29.0) | 36 (22.5) | 40 (30.3) | 54 (19.1) | 242 (23.9) |
Moderate | 73 (28.5) | 55 (30.1) | 40 (25.0) | 33 (25.0) | 85 (30.0) | 286 (28.2) |
Severe | 34 (13.3) | 18 (9.8) | 8 (5.0) | 13 (9.8) | 24 (8.5) | 97 (9.6) |
Anxiety | 147 (57.4) | 54 (29.5) | 82 (51.3) | 77 (58.3) | 174 (61.5) | 534 (52.7) |
Depression (PHQ-9) | ||||||
None-minimal (0–4) | 69 (27.0) | 35 (19.1) | 40 (25.0) | 33 (25.0) | 68 (24.0) | 245 (24.2) |
Mild (5–9) | 91 (35.5) | 58 (31.7) | 65 (40.6) | 39 (29.5) | 71 (25.1) | 324 (32.0) |
Moderate (10–14) | 45 (17.6) | 48 (26.2) | 33 (20.6) | 24 (18.2) | 54 (19.1) | 204 (20.1) |
Moderately severe (15–19) | 33 (12.9) | 27 (14.8) | 17 (10.6) | 25 (18.9) | 47 (16.6) | 149 (14.7) |
Severe (20–27) | 18 (7.0) | 15 (8.2) | 5 (3.1) | 11 (8.3) | 43 (15.2) | 92 (9.1) |
Health outcome | Comorbidity | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Sleep difficulties | Anxiety | Depression severity | |||||||||
No sleep difficulties | Mild | Moderate | Severe | No | Yes | None-minimal | Mild | Moderate | Moderately severe | Severe | |
Mental component summary (SF-36v2) | 42.9 | 38.0* | 36.4* | 33.1* | 43.7 | 36.6* | 47.1 | 41.1* | 37.9* | 34.7* | 29.1* |
Physical component summary (SF-36v2) | 42.9 | 42.9 | 40.0* | 40.6* | 46.2 | 46.2 | 44.6 | 44.3 | 42.7* | 41.9* | 42.5* |
Health utilities (EQ-5D-5L) | 0.66 | 0.63 | 0.52* | 0.46* | 0.76 | 0.66* | 0.76 | 0.70* | 0.65* | 0.56* | 0.42* |
Absenteeism % (WPAI-GH) | 21.5 | 23.0 | 25.4 | 29.4* | 12.5 | 17.4* | 28.6 | 32.8 | 36.3* | 40.5* | 43.5* |
Presenteeism % (WPAI-GH) | 45.5 | 47.9 | 55.9* | 59.4* | 35.1 | 42.5* | 36.3 | 40.0 | 52.0* | 60.2* | 62.3* |
Overall work impairment % (WPAI-GH) | 52.3 | 53.7 | 61.7* | 69.7* | 39.9 | 49.3* | 47.8 | 51.8 | 65.6* | 74.4* | 74.7* |
Activity impairment % (WPAI-GH) | 47.7 | 53.3* | 63.6* | 65.1* | 41.6 | 49.8* | 37.4 | 44.9* | 54.2* | 61.8* | 66.9* |
Number of physician visits in past 6 months | 9.2 | 10.0 | 12.2* | 14.3* | 6.7 | 9.7* | 7.8 | 9.4* | 11.2* | 11.3* | 14.5* |
Number of emergency room visits in past 6 months | 0.63 | 0.55 | 0.65 | 1.05* | 0.45 | 0.51 | 0.55 | 0.70 | 0.89* | 0.81 | 0.69 |
Number of hospitalizations in past 6 months | 0.38 | 0.46 | 0.45 | 0.43 | 0.32 | 0.36 | 0.30 | 0.37 | 0.58* | 0.53* | 0.43 |