Impact and Associations of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States

Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood. OBJECTIVE: The aim of the study was to characterize the impact and associations of OOP health care expenses for AD. METHODS: A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447). RESULTS: Respondents with monthly OOP expenses greater than $200 were 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 (P < 0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression (P < 0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11–6.19], P = 0.04), comorbid asthma (1.42 [1.07–1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62–4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45–3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31–6.27], P < 0.0001). CONCLUSIONS: Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes. Capsule Summary: • Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood. • The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers. • Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact.