To the Editor,
Atopic dermatitis (AD) is associated with immense patient-burden, and as such, the voice of the patient is critical when designing studies, particularly for something as personal as day-to-day out-of-pocket (OOP) expenses. Previous studies analysing costs have utilized claims-based and/or population-level data, which is unable to fully take into account the individual financial burden of AD. Utilizing data gathered from this study, we initially published a manuscript in Dermatitis focused exclusively on individual categories of OOP expenses among AD patients.1 Our aim with this manuscript was to better describe the impact of these costs and associations with measures of disease activity – purely from the patient perspective. Though there is not a validated tool specifically designed to assess financial impact for AD patients, Likert-type scales are commonly used in epidemiologic studies to understand the spectrum of a particular trait or concept. Rather than outlining specific criteria to explain impact, which may vary widely between patients in different financial situations, we simply sought to explore how AD patients gauged their individual financial situation. Utilizing this data, in future studies, we may then be able to better design validated tools to assess financial burden.
We queried patients directly about various facets of their disease diagnosis and management. Self-report of AD diagnosis has shown good reliability in multiple reports, including those not cited in our manuscript.2 While answers to questions such as number of healthcare provider (HCP) visits and number of prescription medications can also be assessed through non-patient-centered routes, such as retrospective chart review or claims-based analysis, each has limitations to capture patients who may see multiple HCPs in multiple settings and receive multiple prescription medications. These types of study designs still remain fruitful sources for follow-up studies examining associations with costs.
We directly queried patients about their self-assessment of disease severity, which has been well-studied in both clinical and research settings. Notably, patient-reported AD severity has been validated in multiple studies as an assessment for overall AD severity.3,4 Control is a more complex concept given varying definitions across studies and HCPs, and while our single question of patient-reported control was the most feasible, validated multi-question patient-reported outcome measures have been recently developed for more systematic measure of AD control.5
Regardless of the limitations associated with a cross-sectional, survey-based approach, our data reveal a high burden of disease associated with OOP costs and financial impact among individuals with AD. Based on these findings, future longitudinal studies may then be designed using validated measures of disease activity and patient-reported outcomes to best understand associations and predictors of cost over time.
Abbreviations used:
- AD
atopic dermatitis
- OOP
out-of-pocket
- HCP
healthcare provider
Footnotes
Conflicts of interest: Raj Chovatiya has served as an advisory board member, consultant, and/or investigator for Abbvie, Arcutis, Arena, Dermavant Incyte, National Eczema Association, Pfizer, Regeneron, and Sanofi-Genzyme, and speaker for Abbvie, Incyte, Regeneron, Sanofi-Genzyme, and UCB.. Jonathan Silverberg reports personal fees from Abbvie, Anaptysbio, Asana, EliLilly, Galderma, GlaxoSmithKline, Kiniksa, Leo, Menlo, Pfizer, Realm, Regeneron-Sanofi, and Roivant, and grants from GlaxoSmithKline, Regeneron-Sanofi, and Galderma. Wendy Begolka and Isabelle Thibau declare no competing interests.
References
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