Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study)

The Supporting Role of Hyperbaric Oxygen Therapy in Atopic Dermatitis Treatment

Over the past decades, atopic diseases have emerged as a growing global health concern. The Global Report on Atopic Dermatitis 2022 estimated that approximately 223 million people worldwide were living with atopic dermatitis in 2022, with around 43 million being children or adolescents. The financial burden associated with the treatment of this condition poses a significant challenge for both healthcare systems and patients. The current therapeutic approach for atopic diseases primarily focuses on symptomatic management, aiming to mitigate the effects of an overactive immune system. The most widely used treatments include topical or systemic corticosteroids, which suppress inflammation, and emollients, which help restore the skin barrier function. However, prolonged corticosteroid use is associated with adverse effects, including impaired immune response and reduced ability to combat external and internal threats. Consequently, there is a growing interest in developing alternative therapeutic strategies for managing atopic dermatitis. Among these emerging treatments, hyperbaric oxygen therapy (HBOT) appears particularly promising. HBOT has a beneficial effect on the vascular and immune systems, which results in improved functioning of tissues and organs. This therapy has demonstrated efficacy in promoting wound healing, particularly in conditions such as thermal burns and diabetic foot ulcers. Given these properties, HBOT is being tested as a potential adjunctive therapy for atopic dermatitis and other allergy-related diseases. In this paper, we present the current state of knowledge regarding the application of HBOT in the treatment of atopic and immune-mediated conditions, with a focus on its immunomodulatory and regenerative effects.

Economic burden of atopic dermatitis in Portugal: a cross-sectional study

Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impacts patients' quality of life and imposes substantial economic burdens due to direct medical costs and indirect costs such as absenteeism and loss of productivity. This study aimed to quantify the economic impact of AD in Portugal. A cross-sectional study was conducted on AD-diagnosed Portuguese residents using a 70-question survey, distributed between June 2019 and January 2020, including DLQI, EQ-5D, and VAS scales, to assess AD's 12 months impact. Statistical analysis included univariate and bivariate methods with post-stratification by disease severity. Findings revealed a mean DLQI score of 9.4 and a 24% productivity loss equating to 50 workdays annually. The economic impact calculated from the participation in the labor market totaled €1.477 million, including €43 million from absenteeism, €1.295 million from presenteeism, and €139 million of missed days by family members. The economic value of time spent treating the disease amounts to €311 million. The total annual cost of treating the disease is shared between the NHS (€218 million) and the patient out-of-pocket cost (€800 million). These results highlight AD's significant economic burden in Portugal, underscoring the need for comprehensive strategies to improve disease management, access to dermatological care, and quality of life. This study emphasizes the importance of investing in AD health services and promoting access to effective treatments to achieve economic and societal benefits.

Higher Occurrence of Ocular Surface Disease Symptoms in Patients with Atopic Dermatitis: Data from 57,464 Subjects in the FOREVER Cohort

Background: Ocular comorbidity in atopic dermatitis (AD) is known, but ocular surface disease (OSD) symptoms do not always result in a physiciańs diagnosis. Objective: To investigate the occurrence of OSD symptoms and self-reported vision and health in a general population and explore their association with AD. Methods: A cross-sectional questionnaire study using the nationwide population-based FOREVER cohort of Danish adults. The occurrence of OSD symptoms, self-reported vision and health, and their association with AD were investigated using logistic regression models. Results: A total of 57,464 (85%) out of 67,178 participants completed the questionnaire. 1,298 had current AD, 5,198 had a history of AD, and 50,968 never had AD. The occurrence of one or more OSD symptoms was associated with both current (adjusted odds ratio, 1.19; 95% confidence interval, 1.05-1.34; P = 0.006) and previous AD (1.16; 1.09-1.23; P < 0.001), compared to those who never had AD, after adjusting for age, sex, smoking status, and atopic comorbidities (asthma and rhinitis). Participants with current and previous AD also rated their overall health "worse" (1.29; 1.16-1.43; P < 0.001) (1.12; 1.06-1.18; P < 0.001), compared to those who never had AD. Conclusions: The occurrence of OSD symptoms and worse self-rated vision and health are associated with AD in a general population.

The burden of atopic dermatitis in adults in Italy

BACKGROUND

Moderate-to-severe atopic dermatitis (AD) generates a considerable consumption of healthcare resources and significant economic consequences for the patients and their families, healthcare systems (NHS) and society. Several studies on the burden of AD in paediatric patients are available in literature, while data in adults is scant. The purpose of this study was to estimate the direct and indirect costs of moderate to severe AD in adult patients in Italy.

METHODS

Patients with Eczema Area and Severity Index (EASI) Score >20 were included in a multicentre, observational study conducted in six outpatient dermatology clinics throughout the national territory. Data were retrospectively gathered through a case report form investigating healthcare resources consumption, out-of-pocket expenses and patients' and caregivers' productivity loss. Descriptive statistics was used to illustrate data. Univariate generalized linear model with gamma distribution and identity function link was used to describe association between costs and disease severity.

RESULTS

A total of 50 patients with a diagnosis of moderate-to-severe DA (EASI Score ≥20), equal to 89% of the total, were included in the analysis. The total annual burden of the disease, direct and indirect costs, amounted to € 4284 per patient; 19.3% accounted for direct medical costs, 19.9% for direct non-medical and 60.8% for indirect costs due to productivity loss.

CONCLUSIONS

Moderate-to-severe AD in adults represents an important cost for the society imposing a high financial burden for the NHS, but even more for patients and caregivers. Results from this study may support identification of potential factors impacting on the choice of new therapeutic options to improve the clinical and economic management of this devastating disease.