Prevalence and cost of severe chronic hand eczema refractory to topical potent corticosteroids

INTRODUCTION & OBJECTIVES: Earlier research has shown that Hand Eczema (HE) is often work-related, widespread, potentially disabling and costly, but often misdiagnosed and mistreated. Severe Chronic Hand Eczema (CHE) can be particularly burdensome, especially among severe patients refractory to therapy. We assessed cost-of-illness of severe CHE patients refractory to topical potent corticosteroids and their prevalence among HE patients accessing dermatology centres MATERIAL & METHODS: a naturalistic, multicentre study was conducted in 14 Italian dermatology centers. HE patients aged ≥18 years, consecutively accessing the participating centers through a 6-month period were enrolled. Socio-demographic and clinical data were collected for all patients, while direct, indirect costs and HRQol data were collected on severe refractory CHE patients. HRQoL was collected with the EQ-5D and the condition-specific Dermatology-Life-Quality-Index (DLQI, having a summary score ranging from 0 to 30, higher score corresponds to more impaired HRQoL). Direct and indirect costs data were collected through a retrospective 8-week time horizon, using the societal perspective. RESULTS: in total 981 HE patients were enrolled (mean age+SD=39.1+15.1, 35.9% male), 11.0% had severe refractory CHE. DLQI mean+SD sum score was 11.3+6.3. With EQ-5D 96.2% of patients reported moderate or severe pain/discomfort, 73.1% problems with usual activities, 55.8% anxiety/depression and 52.9% problems with self-care. VAS mean+SD=60.4+23.3. On average hospitalizations cost 67.3€/patient-month, travels cost 43.4€/patient-month, specialist visits cost 41.0€/patient-month, other products (gloves, gauze bandage, vacuum cleaner, cosmetics) cost 27.2€/patient-month, diagnostic exams cost 19.6€/patient-month, non pharmacological therapy (emollients, galenic products, soap, UV-therapy) cost 18.7€/patient-month, pharmacological therapy cost 18.2€/patient-month. Patients lost on average 4.9 workdays/patient-month for reasons attributable to their disease. CONCLUSIONS: Approximately one tenth of HE patients accessing dermatology centers have severe refractory CHE. These generate high costs to manage their condition, and have a significant productivity loss and a poor HRQoL. An appropriate diagnosis and treatment is necessary to efficiently manage the disease.