Mohammad KA Basra; Muhammad Shahrukh


Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(3):271-283. 

In This Article

Expert Commentary

Skin diseases are among the most common health problems worldwide. According to a UK-based study the prevalence of skin diseases in the community is approximately 55%.[8] Many skin diseases cause significant morbidity to the patient and substantial cost to the society.[159,160] Some of the skin diseases simply itch or burn, whereas others may persist in chronic form and can lead to significant disfigurement and disability and in some cases their effects on an individual's QoL may be more pronounced than those of some major chronic medical conditions such as asthma or diabetes.[30,159,161] Personal and social relationships and employment may be affected and negative emotions, such as shame and embarrassment, may develop in the patients. Lack of confidence and feelings of depression are of major concern in these patients, which may result in serious consequences such as suicide. The social impact of skin diseases can also be significant and results in interference with patients' daily activities, restrict their active participation in sports and other leisure activities. Patients' jobs may be affected due to a number of reasons; for example different objects at work may exacerbate irritation of the skin in eczema and psoriasis patients, some patients have to repeatedly take time off work either for treatment purpose or due to recurrent worsening of their conditions. Young people can also have significant impact of the skin disease; for example, they may not be able to concentrate on their study at school/college because of lack of sleep.[53] Not only this, sufferers may have interpersonal difficulties, which can result in fragile relationships at work or at home.[87] Patients with visible skin lesions, such as in acne, find it difficult to develop relationships with the opposite sex. A sense of rejection is found in diseases such as vitiligo and leprosy, which results in marriage difficulties especially in female patients.

The devastating effects of skin diseases on individuals' lives have been ignored in the past, basically because there were no effective methods to quantify them. However, with the availability of a number of health status and QoL measures in the last two decades, effects of skin disease can be measured in an efficient way. These instruments can provide useful information from patients' perspectives and, therefore, help in outlining the management plan with the inclusion of the patient's opinion and tailored according to their individual needs. These instruments are, therefore, welcomed by patients as they confer in them a feeling of empowerment by giving them voice to express the impact of their skin disease to the healthcare professionals.

The economic aspect of skin diseases is also an important element of the assessment of the overall burden of skin diseases in the community. Evaluation of the economic burden of any disease should include both the direct medical cost to the health services and patients as well as the indirect cost to the society due to the patient mortality and morbidity resulting in loss of productivity. Utility measures, such as time trade-off, standard gamble and WTP[36,162] are effective means to assess the economic impact of a disease from patients' perspective.

In conclusion, burden of disease is a multidimensional concept and is influenced by a number of different factors. A multitude of different methods, such as epidemiology, biostatistics, economics, psychometrics and decision analysis, may be employed in determining the burden of a disease. Since most of the skin diseases are chronic in nature, a significant long-term morbidity is associated with them. Different factors that contribute to the burden of skin disease not only include psychosocial impact on the patients but also on family members, as well as the economic consequences on the patient and on the society. It is important to quantify the burden of skin disease both for public perception and because of its implications for resource allocation and policy making. For best medical outcomes, there is a need for a holistic approach to a 'patient-centered' management strategy involving not only pharmacological therapy but also patient and family education, psychosocial support and efforts to improve the patient-physician relationship.


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