Cost-of-illness of psoriasis - results of a German cross-sectional study.

BACKGROUND: Though psoriasis poses a substantial chronic socio-economic burden, few studies have addressed the economic impact in Germany. OBJECTIVES: The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective. METHODS: A cross-sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardized questionnaires of illness-related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non-parametric tests. RESULTS: Complete data were obtained from 1158 patients in 132 centres. Annual average costs for patients with psoriasis: total costs € 5543 ± € 8044, systemic treatment costs (paid by the statutory health insurances [SHI]) € 3733 ± € 7322, out-of-pocket costs € 224 ± € 406, total SHI costs € 4940 ± € 7533, direct costs € 5164 ± € 7581 and indirect costs € 379 ± € 2087. Significant higher costs in male and significant lower costs in 65+-year-old patients were found. CONCLUSIONS: Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out-of-pocket and indirect costs towards systemic drug costs.

Cost-of-illness of patients with lymphoedema.

BACKGROUND: Chronic lymphoedema is characterized by a continuous need for medical treatment, many comorbidities and impaired quality of life. In Germany, about 4.5 million patients are affected by lymphoedema. Thus, lymphoedema causes high direct and indirect costs, even more in case of complications such as erysipelas and ulcers. OBJECTIVE: The aim of this study was to determine the costs of illness of community lymphoedema patients living in the metropolitan area of Hamburg, Germany. METHODS: An observational cross-sectional study in patients with lymphoedema and combined lipolymphoedema of any origin was performed analysing direct and indirect costs for the patients, the statutory health insurance and society. RESULTS: In total, 348 patients (90.8% female) were examined and interviewed. The mean age of the patients was 57.3 ± 14.5 years. On average, the total costs per patient and year were € 5784, of which € 4445 (76.9%) were direct costs and € 1338 indirect costs. Within the direct medical costs, € 3796 were accounted for the statutory health insurances and € 649 for the patient. The main cost drivers were costs for manual decongestive therapy and disability costs. CONCLUSION: Chronic lymphoedema is associated with high direct and indirect costs. This community-based study is the first cost analysis of chronic lymphoedema and combined lipolymphoedema giving insights to economic impact of lymphoedema treatment. There is a high need for structured disease management programs in order to diagnose and treat lymphoedema early and to avoid complications, thus limiting socio-economic burden.

Evaluation of patient-relevant outcomes of lymphedema and lipedema treatment: development and validation of a new benefit tool.

OBJECTIVES: Patient-relevant treatment benefit is traditionally measured with health-related quality of life (HRQoL) instruments. The Patient Benefit Index (PBI) methodology allows for a more direct measurement, with the patients rating both importance and achievement of treatment goals. Here, we developed and validated a PBI version specific for the assessment of benefit in lymphedema and lipedema treatment (PBI-L). METHODS: The development included five steps: (1) open item collection; (2) consensus of items in a multidisciplinary expert panel; (3) application of the German PBI-L in a cross-sectional study (n = 301); (4) translation into English; (5) application of the English PBI-L in a randomized clinical trial (n = 82). Subscales were developed using factor analysis. Construct validity was analyzed by correlating PBI-L and convergent criteria such as HRQoL and quality of care. To test for responsiveness, the association to change in HRQoL measures was computed. RESULTS: Floor and ceiling effects were low. There were few missing values. Two well-interpretable subscales were found with Cronbach's alpha >0.8 each. Global and subscale scores correlated with convergent criteria and with change in disease-specific HRQoL, but not with change in generic HRQoL. CONCLUSIONS: The PBI-L is an internally consistent, valid, and responsive instrument for the assessment of patient-relevant benefit of edema treatment.

Willingness to pay and quality of life in patients with atopic dermatitis.

Atopic dermatitis (AD) is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and quality of life (Qol) in AD patients and (2) to compare the results with data on other chronic skin diseases. To collect data, a non-interventional, cross-sectional nationwide postal survey on adult patients with clinically diagnosed AD was performed; socio-demographic data, clinical features/symptoms, WTP and QoL were recorded. WTP was assessed in three different approaches, including relative and absolute figures. Data from n = 384 AD patients (mean age 42.0, range 18-92, 69.8 % female) were analyzed. WTP for complete healing was on median 1,000 (average 11,884) and exceeded WTP in rosacea (median 500) but not in vitiligo (median 3,000). Mean Dermatology Life Quality Index (DLQI) was 8.5 (vitiligo 7.0; psoriasis 6.7; rosacea 4.3) and correlated with pruritus, xerosis and disturbed sleep. WTP and DLQI correlated only marginally (r s = 0.134, p = 0.01). In conclusion, AD patients show high WTP and markedly reduced QoL compared to other chronic skin diseases.

Cost-of-illness of patients with chronic hand eczema in routine care: results from a multicentre study in Germany.

BACKGROUND: 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. OBJECTIVES: To determine the direct and indirect costs of CHE under routine conditions in Germany from the societal perspective. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.