Mohammad KA Basra; Muhammad Shahrukh


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

In This Article

Methods of Measuring the Burden of Skin Diseases

Measurement of the burden of skin diseases comprises measurement of a number of different parameters, such as epidemiology, financial cost, impact on patient's QoL, impact on the family and the society. QoL is usually assessed by using standardized and validated questionnaires that are either applicable to a wide variety of diseases (generic) or for a single disease only (disease-specific) or by using preference-based or utility measures.[23]

Generic Health Measures

These questionnaires are used to assess the impact of a medical disorder on the QoL that affect different organ systems including skin conditions. The main advantage is their ability to compare different diseases, such as cardiac diseases, with skin diseases.[20] An example of a generic measure frequently used in dermatology is short form (SF)-36, which has been used to measure patients' QoL in acne[24] and psoriasis.[25] Euro-QoL 5D (EQ-5D) is another generic measure that has been used in acne[26] and psoriasis.[27]

Dermatology-specific Measures

The dermatology-specific questionnaires are specifically designed for the assessment of the QoL in patients with different skin conditions. Examples include the Dermatology Life Quality Index (DLQI),[28] Skindex[29] and the Dermatology Quality of Life Scales (DQOLS).[30] The DLQI, developed in 1994, was the first dermatology-specific QoL instrument. It is a simple ten-question validated questionnaire that has been used in 33 different skin conditions in 32 countries and is available in 55 languages.[31] Its use has been described in over 500 publications, including 30 multinational studies. Currently, the DLQI is the most frequently used instrument in studies of randomized, controlled trials in dermatology.[31]

Disease-specific Measures

These measures enquire about the specific aspects of QoL of a particular disease. These instruments are likely to be more responsive to change, but are not comprehensive in providing cross-condition comparisons. A large number of disease-specific measures for different skin diseases have been developed and used for the last 20 years, for example, Psoriasis Disability Index (PDI),[32] Cardiff Acne Disability Index,[33] Quality of Life Index for Atopic Dermatitis (QoLIAD)[34] and Urticaria Questionnaire.[35]

Utility Measures

Utilities are generic instruments used to assess the patients' preferences for health in quantitative terms.[36] The evaluation is based on a hypothetical value placed by patients on a scale between 0 and 1, where 0 represents death and 1 the perfect health.[36] The main types of utility measures are time trade-off, quality-adjusted life-year (QALY), willingness to pay (WTP), standard gamble and the vertical rating scale.

In dermatology, utility measures have occasionally been used to assess dermatological patients' preferences for their health status. For example, Finlay and Coles used the time-trade off technique in patients with psoriasis,[37] QALY has been used acne,[38] WTP has been used in acne,[39] psoriasis[40] and atopic eczema.[41]

Quality-of-life Measures for the Family

The impact of skin disorders on patients' QoL is well recognized. However, the secondary impact of a patients' skin disease on the immediate family members or partners is under-investigated and under-documented. Recently, in order to highlight the secondary impact of skin diseases on patients, a new concept - the Greater Patient concept - was introduced[42] and a dermatology-specific generic questionnaire (the Family Dermatology Life Quality Index [FDLQI]) was developed to measure the impact of different skin diseases on patients' family or partners.[43] Parents' Index of Quality of Life in AD (PIQoL-AD) is an atopic eczema-specific measure used to assess the impact of atopic eczema on families of young children.[44]


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