Girolomoni Giampiero, Luger Thomas, Nosbaum Audrey, Gruben David, Romero William, Llamado Lyndon John, DiBonaventura Marco
Department of Medicine, Università di Verona, Verona, Italy.
Department of Dermatology, University of Münster, Münster, Germany.
Dermatol Ther (Heidelb). 2021 Feb;11(1):117-130. doi: 10.1007/s13555-020-00459-8. Epub 2020 Nov 12.
Atopic dermatitis (AD) is a common inflammatory disease of the skin, which may have a substantial impact on patients' health-related quality of life (HRQoL). The aim of this study was to quantify the economic burden (direct and indirect costs) of moderate-to-severe AD and evaluate the prevalence and impact of psychosocial comorbidities among patients in the European Union-5 (France, Germany, Italy, Spain, and the UK).
Data were analyzed from the 2017 EU5 National Health and Wellness Survey. Respondents with a physician diagnosis of AD/eczema who were considered to have moderate-to-severe AD based on a Dermatology Life Quality Index (DLQI) score ≥ 6 were included. Direct costs, indirect costs, and psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) were reported descriptively. Generalized linear models were used to examine the relationship between psychosocial comorbidities and health outcomes (the Short Form-36 version 2 [SF-36v2], EuroQoL 5-dimension 5-level, Work Productivity and Activity Impairment questionnaire, and healthcare resource utilization).
Overall, 1014 patients were included in the analysis. Total annual direct costs ranged from €2242 to €6924 and total annual indirect costs ranged from €7277 to €14,236, depending on the level of disease severity. Sleep difficulties, anxiety, and depression were reported by 61.6%, 52.7%, and 75.8% of patients, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores from SF-36v2 and increased overall work impairment (p < 0.05 for all).
A significant economic burden was observed for patients with moderate-to-severe AD. Sleep difficulties, depression, and anxiety were observed in more than half of moderate-to-severe AD patients and were significantly associated with decrements in HRQoL and with work-related impairment. Reducing the burden of these psychosocial comorbidities in AD could have significant benefit to patients and society.
特应性皮炎（AD）是一种常见的皮肤炎症性疾病，可能对患者的健康相关生活质量（HRQoL）产生重大影响。本研究的目的是量化中度至重度AD的经济负担（直接和间接成本），并评估欧盟五国（法国、德国、意大利、西班牙和英国）患者中社会心理合并症的患病率及其影响。
对2017年欧盟五国国民健康与幸福调查的数据进行分析。纳入那些经医生诊断为AD/湿疹且根据皮肤病生活质量指数（DLQI）得分≥6被认为患有中度至重度AD的受访者。对直接成本、间接成本和社会心理合并症（基于自我报告的睡眠困难和焦虑、基于患者健康问卷-9的抑郁）进行描述性报告。使用广义线性模型来研究社会心理合并症与健康结果（简短形式-36第2版[SF-36v2]、欧洲五维度五水平量表、工作效率和活动障碍问卷以及医疗资源利用）之间的关系。
总体而言，1014名患者纳入分析。根据疾病严重程度，每年的直接总成本在2242欧元至6924欧元之间，每年的间接总成本在7277欧元至14236欧元之间。分别有61.6%、52.7%和75.8%的患者报告存在睡眠困难、焦虑和抑郁。这些合并症与SF-36v2中身体和心理成分汇总得分降低以及总体工作障碍增加显著相关（所有p<0.05）。
观察到中度至重度AD患者存在重大经济负担。超过一半的中度至重度AD患者存在睡眠困难、抑郁和焦虑，且这些与HRQoL下降和工作相关障碍显著相关。减轻AD中这些社会心理合并症的负担可能对患者和社会有显著益处。
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