Burden of Disease in Patients With Chronic Hand Eczema: Systematic Literature Reviews of Healthcare Resource Use and Health-Related Quality of Life

OBJECTIVES: Chronic Hand Eczema (CHE) is a fluctuating, multifactorial inflammatory skin disease that affects the hands and the wrists, with symptoms of itch and pain. Patients with CHE experience clinical, occupational, social, and psychological burden, and the disease imposes a considerable economic burden. The burden of CHE was assessed in two systematic literature reviews of healthcare resource use (HCRU) and health-related quality of life (HRQoL).

METHODS: Electronic and supplementary searches were conducted between August and October 2023. Electronic databases (Embase, Medline, Cochrane Library), congress abstracts, and grey literature sources were reviewed. Two reviewers independently assessed the records, while a third reviewer solved discrepancies. All cost data were inflated to a common price year (2022) and converted to euros.

RESULTS: Forty-two studies reported HCRU data. Cost of disease data was reported across distinct healthcare systems and patient management protocols (Germany, Italy, the Netherlands, US). Total annual societal costs per patient ranged from €1,346 to €11,445, comprised of direct costs spanning €460 to €4,304 and indirect costs from €134 to €5,845. Across studies, approximately one third of patients took sick leave in the previous 12 months due to CHE (mean days: 6 to 29.6).

Forty-eight studies examined HRQoL evidence, consistently showing that patients with CHE experienced impaired HRQoL. The Dermatology Life Quality Index (DLQI) was available in most studies, indicating that patients’ quality of life worsened further as the severity of the disease increased (mean DLQI score: mild CHE 4.9 to 7.9; moderate CHE: 6.7 to 12; severe CHE 11.1 to 17.3). Patients with CHE were more likely to self-report clinically significant anxiety and depression symptoms than patients with other dermatological conditions, namely atopic eczema.

CONCLUSIONS: There was considerable heterogeneity in study design, populations, and measures. Overall, the evidence indicates a significant burden of CHE, which increases with disease severity.