Atopic dermatitis (AD) is associated with considerable financial cost. However, the full burden of out-of-pocket (OOP) expenses is not well understood.
Objective
We sought to characterize the OOP health care expenses associated with AD management.
Methods
A 25-question voluntary online survey was administered to National Eczema Association members worldwide (n = 113,502). Inclusion criteria (US residents age ≥18 years who either self-reported had AD or were primary caregivers of individuals with AD) were met by 77.3% (1118/1447) of respondents.
Results
Respondents reported OOP expenses in 3 categories: (1) health care providers and prescriptions, including health care provider visit deductibles (68.7% [686]), prescription co-pays (64.3% [635]), and prescriptions not covered by insurance (48.6% [468]); (2) nonprescription health care products, including moisturizers (94.3% [934]), hygiene products (85.0% [824], allergy medications (75.1% [715]), itch relievers (68.25% [647]), dietary supplements (52.2% [491]), and sleep aids (37.0% [336]); and (3) complementary approaches, including cleaning products (74.7% [732]), clothing/bedding (44.8% [430]), alternative medications (19.0% [180]), and adjunctive therapies (15.9% [150]). The median annual AD OOP expense was US $600 (range, US $0–$200,000), with 41.9% (364) reporting expenditures US $1000 or greater.
Conclusions
Out-of-pocket expenses place a significant financial burden on individuals with AD. Additional studies are needed to better understand associations and impact of OOP costs.
Get full access to this article
View all access options for this article.
References
1.
HuaT, SilverbergJI. Atopic dermatitis in US adults: epidemiology, association with marital status, and atopy. Ann Allergy Asthma Immunol, 2018; 121(5):622–624.
2.
SilverbergJI, SimpsonEL. Associations of childhood eczema severity: a US population-based study. Dermatitis, 2014; 25(3):107–114.
3.
SilverbergJI, GelfandJM, MargolisDJ, et al.Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol, 2018; 121(3):340–347.
4.
DawnA, PapoiuAD, ChanYH, et al.Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol, 2009; 160(3):642–644.
5.
SilverbergJI, GelfandJM, MargolisDJ, et al.Pain is a common and burdensome symptom of atopic dermatitis in United States adults. J Allergy Clin Immunol Pract, 2019; 7:2699–2706.e7.
6.
LiJC, FishbeinA, SingamV, et al.Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study. Dermatitis, 2018; 29(5):270–277.
7.
ChengBT, SilverbergJI. Depression and psychological distress in US adults with atopic dermatitis. Ann Allergy Asthma Immunol, 2019; 123(2):179–185.
8.
ChengBT, SilverbergJI. Association between atopic dermatitis and lower health utility scores in US adults. Ann Allergy Asthma Immunol, 2020; 124(1):88–89.
9.
SilverbergJI, GelfandJM, MargolisDJ, et al.Atopic dermatitis in US adults: from population to health care utilization. J Allergy Clin Immunol Pract, 2019; 7(5):1524–1532.e2.
10.
SilverbergJI, MargolisDJ, BoguniewiczM, et al.Distribution of atopic dermatitis lesions in United States adults. J Eur Acad Dermatol Venereol, 2019; 33(7):1341–1348.
11.
Chiesa FuxenchZC, BlockJK, BoguniewiczM, et al.Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol, 2019; 139(3):583–590.
12.
SilverbergJI.Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study. JAMA Dermatol, 2015; 151(7):743–752.
13.
McClearyKK.Understanding the lived experience of eczema: the “voice of the patient” report on the eczema patient-focused drug development meeting updated 3/20/2020. Available at: http://www.morethanskindeep-eczema.org/report.html. Accessed October4, 2020.
14.
SinghP, SilverbergJI. Outpatient utilization patterns for atopic dermatitis in the United States. J Am Acad Dermatol, 2019.
15.
KwaL, SilverbergJI. Financial burden of emergency department visits for atopic dermatitis in the United States. J Am Acad Dermatol, 2018; 79(3):443–447.
16.
HuaT, SilverbergJI. Atopic dermatitis is associated with increased hospitalization in US children. J Am Acad Dermatol, 2019; 81(3):862–865.
17.
NarlaS, HsuDY, ThyssenJP, et al.Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis, 2018; 29(1):22–31.
18.
DruckerAM, WangAR, LiW-Q, et al.The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol, 2017; 137(1):26–30.
19.
WhiteleyJ, EmirB, SeitzmanR, et al.The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey. Curr Med Res Opin, 2016; 32(10):1645–1651.
20.
SilverbergJI, GelfandJM, MargolisDJ, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol, 2019; 119(548–552):e3.
21.
PatelKR, ImmaneniS, SingamV, et al.Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol, 2019; 80(2):402–410.
22.
LaunoisR, EzzedineK, CaboutE, et al.Importance of out-of-pocket costs for adult patients with atopic dermatitis in France. J Eur Acad Dermatol Venereol, 2019; 33(10):1921–1927.
23.
EichenfieldLF, TomWL, BergerTG, et al.Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol, 2014; 71(1):116–132.
24.
XuS, KwaM, LohmanME, et al.Consumer preferences, product characteristics, and potentially allergenic ingredients in best-selling moisturizers. JAMA Dermatol, 2017; 153(11):1099–1105.
25.
SidburyR, TomWL, BergmanJN, et al. Guidelines of care for the management of atopic dermatitis: section 4. Prevention of disease flares and use of adjunctive therapies and approaches. Consensus Development Conference presented at the Journal of the American Academy of Dermatology; December 2014. Available at: https://linkinghub.elsevier.com/retrieve/pii/S0190962214018878. Accessed October4, 2020.
26.
LuC-L, LiuX-H, StubT, et al.Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med, 2018; 18(1):260.
27.
VieiraBL, LimNR, LohmanME, et al.Complementary and alternative medicine for atopic dermatitis: an evidence-based review. Am J Clin Dermatol, 2016; 17(6):557–581.
28.
HolmJG, ClausenM-L, AgnerT, et al.Use of complementary and alternative therapies in outpatients with atopic dermatitis from a dermatological university department. Dermatology, 2019; 235(3):189–195.
29.
BeikertFC, LangenbruchAK, RadtkeMA, et al.Willingness to pay and quality of life in patients with atopic dermatitis. Arch Dermatol Res, 2014; 306(3):279–286.
30.
FivensonD, ArnoldRJ, KanieckiDJ, et al.The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organization. J Manag Care Pharm, 2002; 8(5):333–342.
31.
ZinkAGS, ArentsB, Fink-WagnerA, et al.Out-of-pocket costs for individuals with atopic eczema: a cross-sectional study in nine European countries. Acta Derm Venereol, 2019; 99(3):263–267.
32.
SinghP, SilverbergJ. Real-world outpatient prescription patterns for atopic dermatitis in the United States. Dermatitis, 2019; 30(5):294–299.
33.
ScottIA, HilmerSN, ReeveE, et al.Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med, 2015; 175(5):827–834.
34.
FlohrC, WeinmayrG, WeilandSK, et al.How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. Br J Dermatol, 2009; 161(4):846–853.
35.
VissingNH, JensenSM, BisgaardH. Validity of information on atopic disease and other illness in young children reported by parents in a prospective birth cohort study. BMC Med Res Methodol, 2012; 12:160.
