Economic burden of atopic dermatitis in India and the USA

Atopic dermatitis presents the variation in prevalence gradients across geographically distinct areas. Hence, the investigation into economic burden of the disease is essential to understanding the impact in developing and developed regions.

Global burden of Atopic dermatitis

The significant contribution towards the assessment of economic burden of Atopic dermatitis across different healthcare system comes from Papsch et al. (2016). The cross-sectional observational study was undertaken in 2014, including China, India, Germany, South Korea and the USA. The relationship between socioeconomic status and health-related quality of life of people suffering from Atopic dermatitis was studied. The citizens belonging to lower income group were found to have worse scores. The difference between the high-income and low-income groups was highest in China (8.5 vs. 10.1), followed by India (9.4 vs. 10.8). These differences were surprisingly comparable to that of USA (7.2 vs. 8.6). It was therefore seen that the systems emphasizing universal health coverage of citizens were highly efficient in bringing the socio-economic gap for health services.

Atopic dermatitis prevalence has shown peculiar rise amongst children, which could possibly attribute to a host of reasons such as pollutants, breastfeeding patterns, high awareness and western lifestyles.  The geographical region of Asia-Pacific continues to show a rise in disease prevalence, affecting not only single individuals, rather entire families. The economic burden generated for an infant suffering from disease amounts to USD 199 to over USD 1,000 per year. The indirect costs of the disease range from USD 8 in the Philippines to USD 2,268 in South Korea.  Another study from Spain, focusing on children, reported the total health care costs of €9.3 million. The annual average unit cost was €1,504. Hence, the statistics show an association between socioeconomic status and the high economic burden of disease around the globe (Sicras-Mainar et al. 2017).

Economic burden in India

The studies for assessment of economic burden of Atopic dermatitis lack in India. Handa et al. 2015 assessed the cost of care of Atopic dermatitis in Indian children, less than the age of 10 years. The study reported the mean cost of treatment to be Rs. 6235.00 ± 3514.00. The direct costs were Rs. 3022.00 ± 1620.00, whereas the mean indirect costs were Rs. 2264.00 ± 2392.00. The severe form of diseases, however, accounts for the total cost of Rs. 8991.00 ± 3129.00 and Rs. 3579.00 ± 948.00 for mild forms. The limitation of the study was the small sample size of 37 patients.

The measures of direct and indirect costs taken in the study are given in the table below. The economic burden in India, therefore, needs to be investigated. This is essential as the disease burden continues to rise and especially impacts younger children. Also, the onset in childhood could pave the way to Atopic march, leading to poorer quality of life in adulthood.

Direct Costs

Indirect costs

Patient/ Caregiver  Costs Provider Cost Loss of earnings of patients
Travel Drugs provided by hospital Loss of earning of caregivers
Lodging Services of doctors Increase household expenditure
Food Cost of treatment modalities Other losses
Paperwork Liasion consultation
Investigations Hospitalization
Hospitalizations Nursing care
Other treatment modalities Infrastructure
Treatment from other sources

Table 1: Measures of direct and indirect cost taken by Handa et al. 2015

Economic burden in the USA

The data from the USA presents a better stance than India. Shrestha et al. (2017) contribute towards the comprehensive presentation of Atopic dermatitis economic burden. The large-scale evaluative study matched the non-disease controls with Atopic dermatitis adults. The commercial, Medicare, and Medi-cal databases were utilized, for the data on co-morbidities, healthcare resource utilization and costs. The findings showed that patients suffering from Atopic dermatitis present high overall burden of co-morbidities. This can result in significant loss of human resources for the country. They were also highly susceptible to developing asthma and rhinitis. Further, the table below shows the mean total per patient costs for control and diseased patients. Those suffering from Atopic dermatitis had to bear higher costs.

Database

Patients suffering from atopic dermatitis

Control patients

Commercial US$10,461 US$7187
Medi-Cal US$16,914 US$13,714
Medicare US$19,462 US$10,408

Table 2: Mean total per patient costs for diseased and control patients from different databases

The same trend persists for the total costs. The commercial and Medicare databases gave information for the insurance claims, patient records, cost of services and prescription drugs. Whereas Medi-cal contains information on demographics, patient records and prescription drugs for low income and disabled residents in California.

Database

Patients suffering from Atopic dermatitis

Control patients

Commercial US$14,580 US$7192
Medi-Cal US$21,779 US$12,490
Medicare US$22,123 US$16,639

Table 3: Total costs for diseased and control patients from different databases

Hence, the study resulted that the patients suffering from Atopic dermatitis had to suffer higher economic burdens. Also, greater the disease severity, greater the burden, also shown by the Indian study.

Burden status

Similar to earlier findings of asthma and rhinitis, assessment of economic burdens for atopic dermatitis present a significant gap between the two nations. On one hand, where the USA has comprehensive and well-managed databases, the Indian scenario presents no such databases. As a result, both countries again differ a lot in terms of economic assessments of diseased conditions. The data available from a single Indian study proves to be insufficient for making any generalizations and also does not help in comparison with the US. This greatly poses the demand on the Indian researchers to pursue aggressive investigations to assess the economic burden of allergies. However, a common trend of increase in disease severity and the economic burden prevailed in both USA and India.

References

  • Handa, S., Jain, N. & Narang, T., 2015. Cost of care of atopic dermatitis in India. Indian journal of dermatology, 60(2), p.213.
  • Papsch, R.B., Howe, T. & Vrabcheva, T., 2016. Comparison of the relationship between socio-economic status and health-related quality of life amongst atopic dermatitis patients across different healthcare systems. The Journal of the International Society for Pharmaeconomics and Outcomes Research, 19(7), p.A453.
  • Shrestha, S. et al., 2017. Burden of atopic dermatitis in the United States: analysis of healthcare claims data in the commercial, Medicare, and Medi-Cal databases. Advances in therapy, 34(8), pp.1989–2006.
  • Sicras-Mainar, A., Navarro-Artieda, R. & Carrillo, J.C., 2017. Economic impact of atopic dermatitis in Adults: A population-based study (IDEA Study). Actas Dermo-Sifiliográficas, 109(1), pp.35–46.
Yashika Kapoor

Yashika Kapoor

Research analyst at Project Guru
Yashika has completed her bachelors in life sciences and holds a masters in forensic sciences. Being a major in forensic biology, she is trained in techniques of DNA extraction and sequencing. She also has hands on experience of dealing with sensitive evidences and case files. She aims at developing her knowledge base through fact based learning. With a penchant for reading, and writing, she likes to keep her facts concrete. She is a confident person and aims at achieving perfection in every task assigned to her. She aims at securing a place in her professional life which allows her to explore different areas relevant to her field of work. Along with academics, she is a creative soul. Food, art and craft are some of her other passions.
Yashika Kapoor

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