German Centre for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing, University Clinics of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany.
Br J Dermatol. 2011 Oct;165(4):845-51. doi: 10.1111/j.1365-2133.2011.10427.x.
It is broadly assumed that costs caused by chronic hand eczema (CHE) are significant. However, there is a lack of cost-of-illness studies on CHE.
To determine the direct and indirect costs of CHE under routine conditions in Germany from the societal perspective.
A cross-sectional survey was conducted in 24 outpatient practices and clinics across Germany. Patients with CHE refractory to potent topical steroids and insured by statutory health insurance were eligible. Clinical and cost data were collected using standardized questionnaires. Severity classes were defined according to a photographic guide and physician global assessment (PGA). Four treatment stages were defined based on the German CHE guidelines: topical treatments only (stage I), additionally ultraviolet (UV) radiation therapy (II), systemic therapy (III) and inpatient treatment (IV). Bivariate associations between costs and severity as well as treatment stage were assessed.
Two hundred and twenty-three patients with CHE (mean age 45·7years, 56% women) enrolled in the study, of whom 63·2% were treated only with topical treatments, 15·7% additionally with UV radiation and 11·7% with systemic treatments. Of all patients, 9·4% had been admitted to hospital. Total costs per year and patient were €2128, including €1742 direct costs and €386 indirect costs. The total costs increased with treatment stages I-IV (P<0·001): €1044, €2307, €2697 and €8407, respectively. Accordingly, costs also correlated with clinical severity.
Patients with CHE refractory to topical steroids incur marked costs to society. The costs increase disproportionately with escalating treatment stages, especially in patients admitted to hospital. Hence, new treatments may help to reduce the societal costs of CHE.
人们普遍认为慢性手部湿疹（CHE）造成的成本是巨大的。然而，目前 CHE 的疾病成本研究还很缺乏。
从社会角度出发，确定德国常规条件下 CHE 的直接和间接成本。
在德国的 24 家门诊诊所进行了横断面调查。合格的患者为 CHE 对强效外用皮质类固醇耐药且有法定健康保险的患者。使用标准化问卷收集临床和成本数据。严重程度分类根据摄影指南和医生整体评估（PGA）来定义。根据德国 CHE 指南，定义了四个治疗阶段：仅外用治疗（I 期）、另外使用紫外线（UV）辐射治疗（II 期）、系统治疗（III 期）和住院治疗（IV 期）。评估了成本与严重程度以及治疗阶段之间的双变量关联。
共有 223 名 CHE 患者（平均年龄 45.7 岁，56%为女性）参与了研究，其中 63.2%的患者仅接受外用治疗，15.7%的患者另外接受 UV 辐射治疗，11.7%的患者接受系统治疗。所有患者中有 9.4%的人住院治疗。每位患者每年的总费用为 2128 欧元，包括 1742 欧元的直接费用和 386 欧元的间接费用。总费用随着治疗阶段 I-IV 的增加而增加（P<0.001）：分别为 1044 欧元、2307 欧元、2697 欧元和 8407 欧元。相应地，费用也与临床严重程度相关。
对外用皮质类固醇耐药的 CHE 患者给社会带来了巨大的成本。随着治疗阶段的增加，成本不成比例地增加，特别是住院治疗的患者。因此，新的治疗方法可能有助于降低 CHE 的社会成本。
