Cost-effectiveness and Quality of Specialized and Routine Care in a German Cohort of Patients with Chronic Pruritus
DOI:
https://doi.org/10.2340/actadv.v103.4868Keywords:
cost-benefit analysis, cost of illness, patient-reported outcome measures, pruritus, quality of healthcareAbstract
Chronic pruritus is a prevalent interdisciplinary symptom with a strong influence on health-related quality of life. Patients need extensive diagnostics and long-term treatment. This retrospective and prospective cohort study compared routine and university-based specialized care in terms of cost-effectiveness and patient benefit. Direct medical and non-medical costs and patient-reported outcomes (PRO; pruritus intensity, quality of life, treatment needs and benefits) were assessed. Data analyses were conducted using descriptive methods and non-parametric statistical tests. A total of 300 adult patients (54.3% female) participated in the study. Six months after the treatment start in a specialized German pruritus care unit, the total costs were significantly reduced (mean total costs 686 € vs 433 € per patient per half year (total cohort); p < 0.001; mean out-of-pocket costs 198 € vs 124 € per half year (total cohort), p < 0.001). Pruritus intensity (numerical rating scale 5.3 vs 3.7, p < 0.001), quality of life (Dermatology Life Quality Index 8.9 vs 5.7, p < 0.001) and patient benefit (Patient Benefit Index Pruritus 1.2 vs 2.1, p < 0.001) improved significantly (total cohort). The results of this study show, that treatment of chronic pruritus patients in a specialized itch centre leads to an improvement in patient benefit and reduces the economic burden at the same time.
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Ständer S, Schäfer I, Phan NQ, Blome C, Herberger K, Heigel H, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology 2010; 221: 229-235.
https://doi.org/10.1159/000319862 DOI: https://doi.org/10.1159/000319862
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k guideline on chronic pruritus. Acta Derm Venereol 2019; 99: 469-506.
https://doi.org/10.2340/00015555-3164 DOI: https://doi.org/10.2340/00015555-3164
Steinke S, Zeidler C, Riepe C, Bruland P, Soto-Rey I, Storck M, et al. Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial. J Am Acad Dermatol 2018; 79: 457-463.e5.
https://doi.org/10.1016/j.jaad.2018.04.044 DOI: https://doi.org/10.1016/j.jaad.2018.04.044
Pereira MP, Steinke S, Bruland P, Ständer HF, Dugas M, Augustin M, et al. Management of chronic pruritus: from the dermatological office to the specialized itch center: a review. Itch (Phila) 2017; 2: e6.
https://doi.org/10.1097/itx.0000000000000006 DOI: https://doi.org/10.1097/itx.0000000000000006
Ständer S, Zeidler C, Magnolo N, Raap U, Mettang T, Kremer AE, et al. Clinical management of pruritus. J Dtsch Dermatol Ges 2015; 13: 101-115.
https://doi.org/10.1111/ddg.12522 DOI: https://doi.org/10.1111/ddg.12522
Ständer S, Ständer HF, Steinke S, Bruland P, Dugas M, Augustin M. Chronischer Pruritus: Versorgung in der Praxis. Hautarzt 2016; 67: 640-647.
https://doi.org/10.1007/s00105-016-3829-8 DOI: https://doi.org/10.1007/s00105-016-3829-8
Lim HW, Collins SAB, Resneck JS, Bolognia JL, Hodge JA, Rohrer TA, et al. The burden of skin disease in the United States. J Am Acad Dermatol 2017; 76: 958-972.
https://doi.org/10.1016/j.jaad.2016.12.043 DOI: https://doi.org/10.1016/j.jaad.2016.12.043
Fleßa S. Gesundheitsökonomik: Eine Einführung in das wirtschaftliche Denken für Mediziner; mit 17 Tabellen. 2., durchges. und aktualisierte Aufl. Berlin: Springer; 2007.
Soto-Rey I, Rehr M, Bruland P, Zeidler C, Riepe C, Steinke S, et al. Electronic collection of multilingual patient-reported outcomes across Europe. Methods Inf Med 2018; 57: e107-e114.
https://doi.org/10.1055/s-0038-1675397 DOI: https://doi.org/10.1055/s-0038-1675397
Storck M, Zeidler C, Rehr M, Riepe C, Dugas M, Ständer S, et al. Validation of pruritus measures gathered with the electronic patient-reported outcome system MoPat. Acta Derm Venereol 2018; 98: 38-43.
https://doi.org/10.2340/00015555-2799 DOI: https://doi.org/10.2340/00015555-2799
Reich A, Riepe C, Anastasiadou Z, Mędrek K, Augustin M, Szepietowski JC, et al. Itch assessment with visual analogue scale and numerical rating scale: determination of minimal clinically important difference in chronic itch. Acta Derm Venereol 2016; 96: 978-980.
https://doi.org/10.2340/00015555-2433 DOI: https://doi.org/10.2340/00015555-2433
Basra MKA, Salek MS, Camilleri L, Sturkey R, Finlay AY. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology 2015; 230: 27-33.
https://doi.org/10.1159/000365390 DOI: https://doi.org/10.1159/000365390
Krause K, Kessler B, Weller K, Veidt J, Chen SC, Martus P, et al. German version of ItchyQoL: validation and initial clinical findings. Acta Derm Venereol 2013; 93: 562-568.
https://doi.org/10.2340/00015555-1544 DOI: https://doi.org/10.2340/00015555-1544
Blome C, Augustin M, Siepmann D, Phan NQ, Rustenbach SJ, Ständer S. Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool. Br J Dermatol 2009; 161: 1143-1148.
https://doi.org/10.1111/j.1365-2133.2009.09328.x DOI: https://doi.org/10.1111/j.1365-2133.2009.09328.x
Héquet D, Huchon C, Soilly A-L, Asselain B, Berseneff H, Trichot C, et al. Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: results of a French multicenter prospective study. PLoS One 2019; 14: e0210917.
https://doi.org/10.1371/journal.pone.0210917 DOI: https://doi.org/10.1371/journal.pone.0210917
Hensen P, Beissert S, Bruckner-Tuderman L, Luger TA,Roeder N, Müller ML. Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting. Eur J Public Health 2008; 18: 85-91.
https://doi.org/10.1093/eurpub/ckm059 DOI: https://doi.org/10.1093/eurpub/ckm059
Zeidler C, Pereira MP, Dugas M, Augustin M, Storck M, Weyer-Elberich V, et al. The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non-lesional skin: a comparative, retrospective, explorative statistical analysis of 4,484 patients in a real-world cohort. J Eur Acad Dermatol Venereol 2021; 3: 738-743.
https://doi.org/10.1111/jdv.16929 DOI: https://doi.org/10.1111/jdv.16929
Shekelle PG, Markovich M, Louie R. An epidemiologic study of episodes of back pain care. Spine (Phila Pa 1976) 1995; 20: 1668-1673.
https://doi.org/10.1097/00007632-199508000-00004 DOI: https://doi.org/10.1097/00007632-199508000-00004
Suzuki H, Aono S, Inoue S, Imajo Y, Nishida N, Funaba M, et al. Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain. PLoS One 2020; 15: e0229228.
https://doi.org/10.1371/journal.pone.0229228 DOI: https://doi.org/10.1371/journal.pone.0229228
Topp J, Augustin M, Usslar K von, Gosau R, Reich K, Reusch M, et al. Measuring patient needs and benefits in dermatology using the Patient Benefit Index 2.0: a Validation Study. Acta Derm Venereol 2019; 99: 211-217.
https://doi.org/10.2340/00015555-3063 DOI: https://doi.org/10.2340/00015555-3063
Kopyciok MER, Ständer HF, Osada N, Steinke S, Ständer S. Prevalence and characteristics of pruritus: a one-week cross-sectional study in a German dermatology practice. Acta Derm Venereol 2016; 96: 50-55.
https://doi.org/10.2340/00015555-2166 DOI: https://doi.org/10.2340/00015555-2166
Stull C, Lavery MJ, Yosipovitch G. Advances in therapeutic strategies for the treatment of pruritus. Expert Opin Pharmacother 2016; 17: 671-687.
https://doi.org/10.1517/14656566.2016.1127355 DOI: https://doi.org/10.1517/14656566.2016.1127355
Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. The cost of an itch: a nationally representative retrospective cohort study of pruritus-associated health care expenditure in the United States. J Am Acad Dermatol 2019; 80: 810-813.
https://doi.org/10.1016/j.jaad.2018.10.025 DOI: https://doi.org/10.1016/j.jaad.2018.10.025
Luk KM, Shaw FM, Zhang C, Culler SD, Chen SC. The annual direct and indirect health care costs for patients with chronic pruritus and their determining factors. J Invest Dermatol 2020; 140: 699-701.
https://doi.org/10.1016/j.jid.2019.07.711 DOI: https://doi.org/10.1016/j.jid.2019.07.711
Ständer S, Pogatzki-Zahn E, Stumpf A, Fritz F, Pfleiderer B, Ritzkat A, et al. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95: 266-271.
https://doi.org/10.2340/00015555-1949 DOI: https://doi.org/10.2340/00015555-1949
Olafsson G, Jonsson E, Fritzell P, Hägg O, Borgström F. Cost of low back pain: results from a national register study in Sweden. Eur Spine J 2018; 27: 2875-2881.
https://doi.org/10.1007/s00586-018-5742-6 DOI: https://doi.org/10.1007/s00586-018-5742-6
Radoičić MJ, Božović BV, Ilić KD, Janković SM, Anđelković JZ, Kostić MJ. Pharmacoeconomic Aspects of low back pain treatment: cost of illness study in the Republic of Serbia. Acta Med Port 2019; 32: 272-278.
https://doi.org/10.20344/amp.10910 DOI: https://doi.org/10.20344/amp.10910
Ekman M, Johnell O, Lidgren L. The economic cost of low back pain in Sweden in 2001. Acta Orthop 2005; 76: 275-284.
https://doi.org/10.1080/00016470510030698 DOI: https://doi.org/10.1080/00016470510030698
Jungen D, Augustin M, Langenbruch A, Zander N, Reich K, Strömer K, et al. Cost-of-illness of psoriasis - results of a German cross-sectional study. J Eur Acad Dermatol Venereol 2018; 32: 174-180.
https://doi.org/10.1111/jdv.14543 DOI: https://doi.org/10.1111/jdv.14543
Müller S, Bieber T, Ständer S. Therapeutic potential of biologics in prurigo nodularis. Expert Opin Biol Ther 2022; 22: 47-58.
https://doi.org/10.1080/14712598.2021.1958777 DOI: https://doi.org/10.1080/14712598.2021.1958777
Whang KA, Kang S, Kwatra SG. Inpatient burden of prurigo nodularis in the United States. Medicines (Basel) 2019; 6: 88.
https://doi.org/10.3390/medicines6030088 DOI: https://doi.org/10.3390/medicines6030088
Diepgen TL, Scheidt R, Weisshaar E, John SM, Hieke K. Cost of illness from occupational hand eczema in Germany. Contact Dermatitis 2013; 69: 99-106.
https://doi.org/10.1111/cod.12038 DOI: https://doi.org/10.1111/cod.12038
Narla S, Hsu DY, Thyssen JP, Silverberg JI. Inpatient financial burden of atopic dermatitis in the United States. J Invest Dermatol 2017; 137: 1461-1467.
https://doi.org/10.1016/j.jid.2017.02.975 DOI: https://doi.org/10.1016/j.jid.2017.02.975
Steinke SIB, Peitsch WK, Ludwig A, Goebeler M. Cost-of-illness in psoriasis: comparing inpatient and outpatient therapy. PLoS One 2013; 8: e78152.
https://doi.org/10.1371/journal.pone.0078152 DOI: https://doi.org/10.1371/journal.pone.0078152
Launois R, Ezzedine K, Cabout E, Reguai Z, Merrhand S, Heas S, et al. Importance of out-of-pocket costs for adult patients with atopic dermatitis in France. J Eur Acad Dermatol Venereol 2019; 33: 1921-1927.
https://doi.org/10.1111/jdv.15581 DOI: https://doi.org/10.1111/jdv.15581
Sohn S, Schoeffski O, Prinz J, Reich K, Schubert E, Waldorf K, et al. Cost of moderate to severe plaque psoriasis in Germany: a multicenter cost-of-illness study. Dermatology 2006; 212: 137-144.
https://doi.org/10.1159/000090654 DOI: https://doi.org/10.1159/000090654
Mohr N, Naatz M, Zeervi L, Langenbruch A, Bieber T, Werfel T, et al. Cost-of-illness of atopic dermatitis in Germany: data from dermatology routine care. J Eur Acad Dermatol Venereol 2021; 35: 1346-1356.
https://doi.org/10.1111/jdv.17203 DOI: https://doi.org/10.1111/jdv.17203
Steinke S, Bruland P, Blome C, Osada N, Dugas M, Fritz F, et al. Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex. Br J Dermatol 2017; 176: 363-370.
https://doi.org/10.1111/bjd.14910 DOI: https://doi.org/10.1111/bjd.14910
Hayani K, Weiss M, Weisshaar E. Clinical findings and provision of care in haemodialysis patients with chronic itch: new results from the German Epidemiological Haemodialysis Itch Study. Acta Derm Venereol 2016; 96: 361-366.
https://doi.org/10.2340/00015555-2280 DOI: https://doi.org/10.2340/00015555-2280
Lehmann M, Cazzaniga S, Simon D, Perruchoud DL, Borradori L, Rammlmair A. Patterns among patients with chronic pruritus: a retrospective analysis of 170 patients. Acta Derm Venereol 2020; 100: adv00068.
https://doi.org/10.2340/00015555-3405 DOI: https://doi.org/10.2340/00015555-3405
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Copyright (c) 2023 Svenja Müller, Sonja Ständer, Mandy Naatz, Matthias Augustin, Sabine Steinke

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