Quantifying costs associated with atopic dermatitis.

■■Quantifying Costs Associated With Atopic Dermatitis Dear Editor, We read with interest the article by Fivenson and colleagues on the total burden of illness associated with atopic dermatitis. The study is important in that it provides a perspective from payer costs to individual productivity. We agree with their conclusion that atopic dermatitis “imposes a financial burden on the health care system.” Using a claims-based approach that included comorbidities associated with atopic dermatitis and eczema, we estimated direct payer costs within a managed care population to average $580 per patient per year (n=35,000), significantly higher than the $167 per patient per year (n=298) found by Fivenson et al. The difference in annual direct payer cost per patient appears mainly to be the result of different cost-accounting methods. We incorporated costs for comorbid conditions; the validity and accuracy of our use of expert opinion to incorporate disease comorbidities were confirmed in a separate report. It appears that Fivenson et al. included direct costs only if they could be tied directly to atopic dermatitis. Although data in the 2 studies are not directly comparable, direct costs in Fivenson et al. are in the range of those in our study if costs for comorbid conditions that we examined are excluded. Other factors might also explain the disparate results. First, we included patients with eczemas as well as atopic dermatitis; however, we would surmise that the average annual direct payer cost would be even higher than $580 if we restricted our study to patients with atopic dermatitis, which is often chronic and difficult to treat. Second, Fivenson et al. report that 7% to 12% of their patients had severe disease. Yet, a recent report estimates the prevalence of severe disease in atopic dermatitis to be 16% of patients. Therefore, average annual direct costs likely would have been higher if more severe patients were included. Regardless, the study by Fivenson et al. is particularly valuable because it quantified various costs associated with atopic dermatitis including out-of-pocket expenses and productivity. Those costs were obtained by survey of patients and families who, although asked about “eczema,” may not ascribe their time and expenses so specifically; therefore, those costs may, in fact, include the effects of at least some comorbidities. Thus, an annual cost burden of $1,022 per patient with atopic dermatitis may be a conservative total (using our total of $580 for payer direct costs plus the Fivenson et al. total of $442 for out-ofpocket expenses and productivity). In addition, neither study attributes a cost to patients’ decreased quality of life. Thus, we still have not captured completely the financial burden of having atopic dermatitis, which is indeed substantial. Further research will be required to fully understand the burden of illness as well as the cost-effectiveness of patient management and intervention programs.