OBJECTIVES : Prurigo nodularis (PN) is a debilitating dermatologic condition characterized by intensely itchy nodules with considerable implications on quality of life (QoL). However, very little is known about its impact on health-related QoL and its economic burden. Our goal was to quantify the health-related QoL and societal economic implications of PN.

METHODS : A cross-sectional survey of 36 patients with PN was administered using the Ontario Health Utilities Index Mark 3 (HUI3) questionnaire. Normative population data (n=4,187) from healthy US adults were obtained from the 2002-2003 Joint Canada/United States Survey of Health. Quality-adjusted life-year (QALY) loss and economic costs were estimated based on comparing HUI3 scores of PN patients to controls.

RESULTS : Patients with PN had a significantly lower overall health utility score compared to the general population, (0.52±0.06 vs. 0.86±0.003, p<0.001), similar to the level of impairment seen in patients with stroke or heart failure. In multivariate regression, PN was associated with worse overall health performance (coefficient -0.33, 95% CI [-0.39 to -0.27]). The decreased health performance was most prominent in the domains of pain (coefficient -0.24, [-0.30 to -0.18]), emotion (coefficient -0.14, [-0.17 to -0.11]), and cognition (coefficient -0.12, [-0.16 to -0.09]). The decreased HUI3 score due to PN correlated to an average of 6.3 lifetime QALYs lost per patient. Using conservative estimates for willingness-to-pay threshold, the average QALY loss from PN translated to an individual lifetime economic burden of $313,783 and a societal lifetime burden of $27.3 billion.

CONCLUSIONS : These results demonstrate that PN is associated with significant health-related QoL impairment, similar to the level experienced by patient with other debilitating chronic conditions. There is significant individual economic burden of PN, which emphasizes the need for further research into effective treatment options.