Epidemiology and Economic Burden of Atopic Dermatitis: Real-World Retrospective Data from a Large Nationwide Israeli Healthcare Provider Database

Abstract

Introduction: Real-world data on the epidemiology and economic burden of atopic dermatitis (AD) are limited. Here we describe the epidemiology and economic burden of AD using electronic healthcare data from Israel.

Methods: A retrospective study was performed using the Maccabi Healthcare Services database. AD incidence in 2008-2017 and point prevalence (AD_prev) on 31 December 2017 were described using diagnosis codes for overall patients, and sex and age subgroups. For AD_prev, severity was defined using recently dispensed treatments for AD. Annual healthcare resource utilization in AD prevalent patients was compared with non-AD matched controls using generalized linear modelling. Direct annual costs were estimated also.

Results: AD incidence was 7.0/1000 person-years; overall prevalence was 4.4% (female patients 4.5%, male patients 4.3%; age 0 to less than 6 months, 0.9%; 6 months to less than 12 years, 11.0%; 12 to less than 18 years, 5.8%; 18 years or older, 2.2%). Among AD_prev (n = 94,483), mild, moderate, and severe AD comprised 57.7%, 36.2%, and 6.1% (adults 43.8%, 46.3%, 9.9%), respectively. Dermatologist and allergist visits and hospitalization rates (at least one) were 40.7%, 6.6%, and 3.8% in 2017. Compared with controls, overall and moderate-to-severe AD were associated with 36% and 52% increases in annual per-person costs (incremental costs $126 and $190).

Conclusions: AD epidemiology in Israel is comparable with other real-world database studies. AD imposes an economic burden that increases with disease severity.

Keywords: Atopic eczema; Epidemiology; Health economics.

Fig. 1

Atopic dermatitis: age- and sex-specific incidence in Israel* (2008–2017 average). AD atopic dermatitis, MHS Maccabi Healthcare Services, mo months; y years. *MHS is a nationwide healthcare insurer and provider with more than 2.3 million members in 2017

Fig. 2

Atopic dermatitis: age-specific prevalence in Israel* by sex (31 December 2017). AD atopic dermatitis, MHS Maccabi Healthcare Services, mo months, y years. *MHS is a nationwide healthcare insurer and provider with more than 2.3 million members in 2017

Fig. 3

Atopic dermatitis: HCRU in past year among AD prevalent patients (by severity)* and non-AD controls.^† Note that high cost outliers were excluded. AD atopic dermatitis, ER emergency room, HCRU healthcare resource utilization, PCP primary care physician, SI systemic immunomodulators, SC systemic corticosteroids, TCI topical calcineurin inhibitor, TCS topical corticosteroids. *For comparison of AD by severity: n = 93,432. ^†For comparison of AD vs non-AD controls: n = 92,632 matched pairs