Fowler Joseph F, Ghosh Arindam, Sung Jennifer, Emani Srinivas, Chang Jane, Den Elana, Thorn Deborah, Person John, Duh Mei Sheng
University of Louisville, Louisville, Kentucky, USA.
J Am Acad Dermatol. 2006 Mar;54(3):448-57. doi: 10.1016/j.jaad.2005.11.1053. Epub 2006 Jan 30.
The impact of chronic hand dermatitis (ChHD) on patient-reported outcomes and economic costs has not been assessed in a US population.
We sought to evaluate the quality of life, work productivity, activity impairment, and health care costs of patients with ChHD versus those without ChHD.
A 13-item self-assessment questionnaire to identify ChHD was developed and validated. Skindex-29 and Work Productivity and Activity Impairment questionnaires were used to assess quality of life and work productivity for ChHD. The survey was mailed to a random sample of 1380 members of a Massachusetts managed care organization (N = 507, response rate = 36.74%). Univariate and multivariate analyses were conducted to determine the incremental effect of ChHD on quality of life, work productivity, and activity impairment. Health insurance claims were used to assess medical costs.
Quality of life, along with work productivity and activity impairment, were significantly worse for patients with CHD than for those without ChHD; however, there was no significant difference in work time missed. After adjusting for significant covariates, a 25% cost increase in total medical costs was found attributable to ChHD, which translates to an incremental cost of $70 per patient per month.
Survey response rate is not high; the survey respondents may not be completely representative of the nonrespondents. The cost burden of ChHD is underestimated because of the omission of over-the-counter drug and indirect costs. The multivariate models had a low goodness of fit indicated by the low R2 statistics.
ChHD has a significant detrimental effect on quality of life, work productivity, activity impairment, and heath care costs. More awareness and treatment of this condition are needed to improve patient outcomes and decrease health care cost.
慢性手部皮炎（ChHD）对美国人群患者报告结局和经济成本的影响尚未得到评估。
我们试图评估慢性手部皮炎患者与非慢性手部皮炎患者的生活质量、工作效率、活动受限情况及医疗保健成本。
开发并验证了一份用于识别慢性手部皮炎的13项自我评估问卷。使用Skindex-29问卷以及工作效率和活动受限问卷来评估慢性手部皮炎患者的生活质量和工作效率。该调查问卷被邮寄给马萨诸塞州一家管理式医疗组织的1380名成员的随机样本（n = 507，回复率 = 36.74%）。进行单变量和多变量分析以确定慢性手部皮炎对生活质量、工作效率和活动受限的增量影响。利用医疗保险理赔数据评估医疗成本。
慢性手部皮炎患者的生活质量、工作效率和活动受限情况显著差于非慢性手部皮炎患者；然而，在缺勤时间方面没有显著差异。在对显著协变量进行调整后，发现慢性手部皮炎导致总医疗成本增加25%，这相当于每位患者每月增加70美元的增量成本。
调查回复率不高；调查受访者可能无法完全代表未回复者。由于未将非处方药和间接成本计算在内，慢性手部皮炎的成本负担被低估。多变量模型的拟合优度较低，由较低的R2统计量表明。
慢性手部皮炎对生活质量、工作效率、活动受限情况和医疗保健成本有显著的不利影响。需要提高对这种疾病的认识并加强治疗，以改善患者结局并降低医疗保健成本。
