Payer Perspectives in Dermatology
Laura Morgan

Previous studies have shown that rosacea and acne have a significant impact on patients’ health-related quality of life (QOL), manifested as shame, embarrassment, anxiety, stress, social phobia, depression, as well as social and employment discrimination.

Furthermore, a 2004 joint study from the American Academy of Dermatology and the Society for Investigative Dermatology showed that each of these 2 conditions is associated with a significant cost burden.1 Specifically, the cost of acne, which affects 50.2 million Americans, was $15 billion in 2004, and the cost of rosacea, which affects 14.7 million Americans, was $2 billion.1

Impact on Quality of Life
However, little data are available on the relative impact of these 2 common skin disorders on QOL relative to other medical conditions. A group of researchers has recently conducted a meta-analysis to compare the impact of rosacea and acne on a patient’s health-related QOL with the impact on QOL of other chronic conditions.2 The results show that the impact of these 2 skin disorders on a patient’s QOL is similar to the impact of other chronic and life-threatening conditions, such as asthma, epilepsy, diabetes, back pain, arthritis, and heart disease.2

Steven R. Feldman, MD, PhD, lead investigator of the study and Professor of Dermatology, Pathology, and Public Health Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC, said in an interview, “As the American healthcare system becomes more restrictive, data from this study may help our patients get continued access to good treatments. Increasingly, we need to demonstrate the value of what dermatologists do, and the impact that skin diseases, such as acne and rosacea, have on our patients’ lives.”

Dr Feldman and colleagues identified studies using 1 of 3 measures to quantify QOL in patients with dermatologic and nondermatologic conditions, including the Short-Form 36 (SF-36) questionnaire, which measures dermatologic and nondermatologic conditions; the dermatology-specific Dermatology Life Quality Index (DLQI) questionnaire; and a generalized willingness-to-pay metric, which measures how much patients are willing to pay to improve or cure their medical condition.2

Studies that used the SF-36 questionnaire revealed that the impact of acne on QOL was similar to the impact of nondermatologic conditions, including asthma, epilepsy, diabetes, back pain, arthritis, and heart disease. (The SF-36 data were not available for patients with rosacea.)

The DLQI scores of impact on QOL in the studies evaluated ranged from 4.3 to 17.3 for patients with rosacea, and from 2 to 17.7 for patients with acne.2 Because of the lack of SF-36 data for rosacea, it was indirectly compared with nondermatologic conditions by replacing rosacea scores with those for psoriasis, a debilitating skin condition that has been likened to other general, chronic medical diseases.

“We couldn’t find generic quality of life measures reported for rosacea, but we were able to use the DLQI data to show that the quality of life impact of rosacea is similar to that of psoriasis, which by extension shows that the impact of rosacea on people’s quality of life is similar to other major medical conditions,” Dr Feldman said.

The DLQI scores for patients with psoriasis were comparable to those of patients with rosacea, ranging from 1.7 to 18.2; these values were higher than those for patients with other dermatologic conditions (eg, chronic urticaria, leg ulcers, and melasma).2 Furthermore, the analysis showed that acne had a greater emotional impact on patients compared with psoriasis in some studies.2

“Psoriasis is a devastating condition. Based on studies using general measures of quality of life, we know that based on the use of generic quality-of-life measures, psoriasis has an impact on quality of life similar to other medical illnesses,” Dr Feldman added.

Willingness to Pay
Willingness-to-pay studies of patients with acne showed patients were willing to pay $169 monthly to cure acne, and $239 annually to relieve the symptoms of acne. These willingness-to-pay values were similar to or more than those for other chronic conditions, including psoriasis, hypertension, angina, hyperlipidemia, atopic eczema, atopic dermatitis, and skin ulcers.2

Only 2 studies have investigated patients’ willingness to pay for rosacea treatment, indicating that patients were willing to pay $3750 for the complete resolution of rosacea, and $109 annually to relieve the symptoms of rosacea; this was less than what they would be willing to pay for acne or psoriasis, but more than for other dermatologic conditions (eg, bullous diseases, cutaneous fungal infections, herpes simplex, vitiligo).2

Dr Feldman concluded, “We need a better understanding of rosacea in general. I think there are studies at the basic science level that are beginning to tease out the pathophysiology of rosacea, and in parallel with that we are getting a new treatment for rosacea. In parallel with both of those things, what we need is a better understanding of rosacea at a higher level, at the level of people and the health systems.”

References

  1. Bickers DL, Lim HW, Margolis D, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology and the Society of Investigative Dermatology. J Am Acad Dermatol. 2006;55:490-500.
  2. Cresce ND, David SA, Huang WW, Feldman SR. The quality of life impact of acne and rosacea compared to other major medical conditions. J Drugs Dermatol. 2014;13:692-697.
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