Fully 42 percent of Americans living with AD spend $1,000 or more out of pocket every year to manage their eczema.

Fully 42 percent of Americans living with atopic dermatitis (AD) spend $1,000 or more out of pocket (OOP) every year to manage their eczema,  accrdong to a new survey from the National Eczema Association (NEA).

While the median annual estimated OOP expense is $600 across all survey respondents, annual OOP costs equal to or exceeding $5,000 were reported by 8.5% of participants, the survey found.

The findings are published (in part) in Dermatitis. 

The 1,118 survey responses provided important new real-world information from a large cross-section of the AD community. Eligible respondents to the 25-question voluntary survey had to be U.S. residents aged 18 year or older, living with AD or providing primary care for someone with AD.  

The study grouped 22 unique expenses into three main categories: prescriptions and healthcare provider office and hospital visits (including co-pays); non-prescription products like moisturizers, dietary supplements, hygiene products and sleep aids; and supportive care items such as clothing, bedding, cleaning products, as well as complementary therapies like traditional Chinese medicine.

Fully 68.7 percent of responders reported OOP copays and/or deductibles for visits to their healthcare provider(s) over the past 30 days, 19 percent indicated OOP expenses for complementary/alternative medicines, yet nearly all responders, 94.3 percent, paid OOP for non-prescription over-the-counter moisturizer. Collectively, the study results highlight the wide array and range of OOP for health-related expenses incurred by patients to manage their disease.  

This study also found that nearly half (48.6%) of AD patient and caregiver respondents had OOP costs for prescriptions not covered by insurance. The resulting financial burden of this finding is especially troubling in light of how many responders additionally reported using multiple prescriptions for treatment; 89.6 percent of responders had at least one prescription to treat their AD, while 57.5 percent had three or more different prescriptions. 

This could provide an opportunity for changes in how treatment options are covered by insurance, and how healthcare providers consider different therapeutic approaches in designing more affordable treatment plans, with knowledge of their patients' perspectives and financial implications. Some suggested treatment recommendations may be unaffordable for patients, either overall, or due to changes in their insurance or financial status over time.  

The survey responses also provide a compelling portrait of how disruptive AD really is, in both frequency and severity, for Americans living with the condition: 74 percent percent of responders indicated their AD was either severe or moderate; 39.4 percent had more than 11 flare days in the past month; and 22.4 percent had seen their healthcare provider(s) at least 5 times in the past year for AD treatment. 

The psychological and emotional impacts of AD combined with its prevalence in the American population also raises urgent questions about the availability and affordability of mental health services, as 36.5 percent of respondents reported additional diagnoses of anxiety and/or depression. However, the article suggests that the "OOP costs for mental health services were quite low among respondents, which was surprising given the strong association between AD and mental health disorders, including depression, anxiety, and psychological distress." 

With less than 15 percent of responders reporting expenses for mental health services, there is need for the healthcare community to increase screening for mental health symptoms, as well as OOP cost-sensitive coverage considerations to facilitate use of these support services by the AD patient community.