Indirect costs of atopic dermatitis (AD) – systematic review and Polish perspective

OBJECTIVE: Atopic dermatitis (AD) is a common chronic, pruritic inflammatory skin disease. It is associated with a high personal burden of illness and economic consequences. The main purpose of this analysis is to present the indirect costs of atopic dermatitis, including their specific aspects. METHODS: The analysis was based on a systematic review of the literature (23 October 2019). Keywords related to indirect costs and AD were used in the search strategy. RESULTS: 35 publications were included in the final analysis. They showed that a significant reduction in the quality of life of patients with atopic dermatitis is associated with high costs from a social perspective. A systematic review of the literature indicates that the costs arising from the absence of AD patients at work (absenteeism) or their reduced effectiveness during the performance of work duties (presenteeism) are much higher than those of people without AD (weekly productivity loss between 3-5%). Factors particularly affecting the amount of costs (direct and indirect) generated by AD include the severity of the disease and its control, as well as the type of treatment used and the patient's response to it. In Europe and USA, annual indirect costs (only productivity loss) due to AD are estimated at 2,3 billion EUR and 619 million USD respectively. Indirect costs in patients with atopic dermatitis are significantly higher than in people without this condition, which is due to reduced work productivity. Available literature indicate that the more advanced the form of AD, the greater the loss of productivity, and thus the higher indirect costs, and this observation is confirmed by data from various countries. The amount of indirect costs in AD is higher in the case of an uncontrolled form of the disease than in the case of a controlled disease. The use of ineffective treatment significantly increases the indirect costs of atopic dermatitis. Currently therapeutic options available in Poland are not sufficiently effective to provide disease control in all patients with AD, are characterized with adverse reactions, their use is limited in time and therefore their use will not bring savings in indirect costs in patients with severe AD. CONCLUSIONS: In this systematic review, we observed some aspect that likely have a major impact on the indirect costs in patients with AD: effectiveness of treatment, disease control (maintenance therapy between successive exacerbations). Ineffective treatments significantly increase the indirect costs of atopic dermatitis.