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Impact of Out-of-Pocket Expenses for Atopic Dermatitis
The past year saw a plethora of surveys and studies designed by the National Eczema Association (NEA) delving into the impact of atopic dermatitis (AD) on patient health, quality of life, care, and more. One area of focus has been out-of-pocket (OOP) expenses and the financial impact of treatment. NEA researchers aimed to characterize the impact and associations of OOP health care expenses in AD by administering a 25-question online survey to NEA members aged 18 years and older with self-reported AD or who were the primary caregivers of patients with AD. With 31 million people1 living with eczema in America, it is crucial for providers to be aware of and recognize the financial burden associated with managing the disease.
The 4 publications from this NEA survey summarized below highlight OOP costs and their impact on patients with AD, as well as how these health care expenses are increased among Black individuals in the United States and how they affect the caregivers of children with AD.
Financial Burden of AD
The first study published in Dermatitis found that many patients with AD face significant financial burden due to OOP expenses.2
Results showed that OOP expenses were reported within 3 broad categories, and included OOP expenses that had otherwise not been previously reported:
- Health care providers and prescriptions, including deductibles (68.7%), prescription copays (64.3%), and prescriptions not covered by insurance (48.6%)
- Nonprescription health care products, including moisturizers (94.3%), hygiene products (85.0%), allergy medications (75.1%), itch relievers (68.2%), dietary supplements (52.2%), and sleep aids (37.0%)
- Complementary approaches, including cleaning products (74.7%), clothing/bedding (44.8%), alternative medications (19.0%), and adjunctive therapies (15.9%)
Additionally, researchers found that the median annual OOP cost for patients with AD was $600 (range: $0–$200000), with 41.9% of participants reporting $1000 or more.
The authors indicated that additional studies are needed to better understand the impact and associations of OOP costs and the financial burden on patients with AD.
AD Health Care Expenses: Impact and Associations
A second study published in Dermatitis found that OOP expenses heavily impact household fi nances for patients with AD.3
According to the results, participants with monthly OOP expenses greater than $200 are more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control. Additionally, participants with OOP expenses greater than $1000 have similar associations, as well as increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression. In total, roughly 64.6% reported a harmful household financial impact of OOP expenses in which predictors included likelihood of severe AD, comorbid asthma, 5 health care provider visits or more in a year, more than $200 monthly OOP expenditures, and $1000 or more in annual OOP expenditures.
The authors concluded, “Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes.”
Burden and Impact of AD Among Black Individuals in the United States
According to the third study published in the Archives of Dermatological Research, there is a significant household financial impact on Black patients with AD, including increased OOP costs.4 Because the burden of OOP expenses among Black patients with AD is not well understood, researchers aimed to characterize the categories and address the impact of OOP health care expenses for management of AD among Black individuals.
Researchers found that Black patients with AD tend to be younger, with a lower household income. They are also more likely to utilize Medicaid, reside in an urban residence, and experience poor AD control and frequent skin infections. The majority of Black patients (74.2%) reported more OOP costs for prescription medications covered by insurance compared with non-Black individuals at 63.6%, whereas costs for prescription medications not covered by insurance were also increased for Black individuals at 65.1% vs 46.5% for non-Black patients. Additionally, OOP expenses for emergency room visits (22.1% vs 11.8%) and outpatient laboratory testing (33.3% vs 21.8%) were significantly higher for Black patients.
Predictors of the financial impact among Black patients included minimally controlled AD, systemic therapy, greater than $200 monthly OOP expenses, and Medicaid. Black patients with Medicaid have increased odds of harmful financial impact than those of Black race or with Medicaid alone.
The authors noted that “targeted interventions are needed to address financial disparities in AD.”
Effect of Costs on Caregivers of Children With AD
The fourth study published in Skin Health and Disease found that caregivers reported increased health care expenses for children with AD compared with adults, and these OOP costs are associated with greater disease severity.5
Most caregivers of children younger than 18 years indicated that they experience moderate (41.9%), severe (21.7%), or devastating (5.9%) financial impact from OOP AD expenses. In addition to increased expenses for hospitalizations; emergency room visits; emollients, hygiene/bathing products, and cleaning products; clothing/bedding; and childcare, they reported increased health care provider visits, comorbid food allergy, cutaneous infections, and topical antimicrobial use compared with adults with AD. There was also a higher total annual expenditure for children with AD vs adults (median: $860 vs $500). Almost half (48.9%) of caregivers were more likely to spend $1000 a year or more, and this level of expense was associated with increased AD severity, flares, health care provider visits, prescription polypharmacy, and step-up therapy use compared with adults. For households with children with AD, Black race was a unique predictor of harmful financial impact.
The authors concluded, “Caregivers of children with AD experience a distinct financial burden consisting of elevated OOP expenses across a variety of healthcare categories.”
Conclusion
With the estimated annual overall cost of eczema exceeding $5 billion in the United States,1 these studies address the looming financial burden that impacts many patients with AD. By better understanding the nature of OOP costs and the economic impact of AD management and treatment, health care providers can strengthen shared decision-making and patient-provider relationships to deliver optimized treatment plans for patients with AD.
References
- Eczema stats. National Eczema Association. Accessed January 12, 2023. https://nationaleczema.org/research/eczema-facts
- Smith Begolka W, Chovatiya R, Thibau IJ, Silverberg JI. Financial burden of atopic dermatitis out-of-pocket health care expenses in the United States. Dermatitis. 2021;32(1S):S62-S70. doi:10.1097/DER.0000000000000715
- Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. Impact and associations of atopic dermatitis out-of-pocket health care expenses in the United States. Dermatitis. 2022;33(6S):S43-S51. doi:10.1097/DER.0000000000000795
- Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. Financial burden and impact of atopic dermatitis out-of-pocket health care expenses among Black individuals in the United States. Arch Dermatol Res. 2022;314(8):739-747. doi:10.1007/s00403-021-02282-3
- Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. The fi nancial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States. Skin Health Dis. 2022:e191. doi:10.1002/ski2.191
