Mohammad KA Basra; Muhammad Shahrukh


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

In This Article

Atopic Eczema

Atopic eczema is a very common and troublesome disease that affects between 10-20% of children in Western communities.[45] The onset is in infancy in 60% of patients and approximately 90% occurs before 5 years of age.[46] A third of these children are also affected as adolescents.[46] The incidence of atopic eczema in the UK increased from 5% in 1946 to 12.2% in 1970.[47] A variable prevelance was reported in another study with 20.4% in Sweden, 6.5-12.7% in Estonia, Latvia and Poland and 3.2 to 4% in Albania and Georgia.[48] The population affected by atopic eczema is reported to have inferior HRQoL and increased psychological distress.[49]

Atopic eczema patients have been known to suffer from different psychosocial problems. A total of 47% of cases were frustrated with their disease, 39% felt embarrassed by their appearance and 35% were reported to be angry most of the time about their appearance.[50] Using SF-36, a generic HRQoL measure, atopic eczema sufferers scored very poorly on the vitality, social functioning and mental health scales.[49] Among children with atopic eczema, increased behavioral problems, such as increased dependency, fearfulness and sleep difficulties, have been reported.[51] These behavioral problems can affect social development as well as can interfere with intellectual development of the child. The relationship between peers and teachers can be affected because of fear of catching infection, the child's physical appearance and limitations on sports participation.[52] Sleep is a major issue for the majority of patients. Itching and scratching often at night affects the sleep. In total, 84% of the atopic eczema patients have difficulty falling asleep, while 79% are awakened by pruritus.[53] In children, on average, 2 h of sleep could be affected, which results in increased drowsiness during daytime and may affect their performance at the school.[54] Sleep deprivation in atopic eczema patients and their parents is one of the most important factors in poor family relationships, as well as poor work performance and decreased coping skills at work and at home.[46,52,54] Owing to the nature of the disease and the way treatment is applied, family members, especially parents, are frequently involved in day-to-day care of the patient. It has been suggested that 2-3 h per day are spent by family members caring for a child with atopic eczema depending on the disease severity.[46]

In addition to its psychosocial effects on patients, atopic eczema also has financial consequences for the family and the society, which may range from US$71 to US$2559 per patient per year.[55] The direct cost of atopic eczema, measured in Australian dollars, according to severity groups, was estimated to be between Aus$216 to Aus$821 per patient per year for moderate-to-severe disease.[46] In a US-based study, the estimated direct cost of atopic eczema patients was $364 million per annum in 1993.[56] A later study found that the third-party payer cost of atopic eczema ranged from US$0.9 billion to US$3.8 billion for patients younger than 65 years.[57] It was concluded that these figures of annual costs of the disease were similar to other chronic diseases such as epilepsy, emphysema and psoriasis.[57]


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