COEUR D’ALENE, ID. – A new study puts a price on the financial and emotional costs of childhood atopic dermatitis – and concludes both are much steeper than generally recognized.
Moreover, among low-income families, a significant correlation was documented between the monthly financial cost of atopic dermatitis care and the emotional burden imposed by the disease as reflected in higher CADIS (Childhood Atopic Dermatitis Impact Scale) scores, Ms. Michelle G. Filanovsky reported at the annual meeting of the Society for Pediatric Dermatology.
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The financial and emotional costs of treating children with atopic dermatitis are steeper than ever, says a new study.
"Our study is the first to correlate financial burden with emotional impact of atopic dermatitis for patients of lower socioeconomic status. This has great implications for how practitioners can help lessen the burden of the disease: Perhaps by helping families lower the cost of disease, we can help lower the emotional burden," observed Ms. Filanovsky, a medical student at Case Western Reserve University, Cleveland.
She and her coinvestigators surveyed parents or other caretakers of 79 children aged 6 months to 12 years with moderate to severe atopic dermatitis who presented to Cleveland dermatology clinics, typically because of a disease flare. Forty-five of the children were covered by Medicaid.
Subjects were queried regarding their total direct and indirect costs for atopic dermatitis care during the past 4 weeks. Direct costs include physician office and emergency department visits, prescription medications, complementary and alternative medicine, and – most importantly – over-the-counter (OTC) products, which are used extensively in atopic dermatitis care. Indirect costs included time missed from work or school and additional child-care expenses.
The disease’s emotional impact was assessed by CADIS on a 1-10 scale. CADIS addresses issues including caregiver sleep disruption and other caregiver concerns, as well as any difficulties the child is experiencing with sleep, school, socialization and conduct, self-esteem, and activity limitations.
The mean personal cost of atopic dermatitis in the month prior to the office visit was $273.78, representing on average more than one-third of a family’s available monthly money, Ms. Filanovsky said. The breakdown was $75.12 in direct costs and $198.66 for indirect costs. Families with commercial health care insurance averaged $130.58 in direct and $436.16 in indirect costs, with much lower costs in the Medicaid group.
OTC products made up the largest portion of direct costs. An average of $15.28 was spent on moisturizers, $9.42 on OTC topical steroids, $8.46 on bath products, and $4.66 on antihistamines. Time missed from work accounted for the bulk of the indirect costs.
Medicaid patients showed a significant linear correlation between CADIS scores and both total monthly costs of atopic dermatitis care and monthly costs adjusted by family size and income. However, commercially insured families did not.
Ms. Filanovsky proposed several measures as worthy of further study to help reduce the financial and emotional burden of atopic dermatitis, including insurance coverage of moisturizers, physician guidance regarding the most cost-effective OTC products, and implementation of afterwork office hours or nurse on-call visits during flares to minimize the indirect cost of care.
Survey respondents received $25 for their participation, with the funds provided by Nestle. Ms. Filanovsky reported no financial conflicts regarding this study.