OBJECTIVES: Atopic dermatitis (AD), also known as eczema, is one of the most common inflammatory skin diseases and has a huge socioeconomic impact. However, the disease is commonly misunderstood as a minor skin condition and few studies have examined the overall economic and humanistic burden of AD to patients, families, healthcare systems and society. We performed a systematic literature review to assess the overall burden of AD in Europe.

METHODS: Medline, Embase and Cochrane databases were searched from 2010 to 2020 to identify studies reporting any aspect of AD burden. Conference, health technology assessment and patient association group websites were also searched from 2016 to 2020. Articles were screened by two independent reviewers according to pre-defined inclusion criteria.

RESULTS: 84 articles fulfilled the inclusion criteria; 30 assessed direct costs and healthcare resource use, 9 assessed patient/family out-of-pocket costs, 17 assessed indirect costs due to work productivity impairment, and 47 assessed impact on quality of life. Some studies reported multiple outcomes. Direct medical costs of up to €6,993 per-patient-per-year (PPPY) were reported for adults with uncontrolled moderate-to-severe (M/S) disease in the Netherlands. Further patient/family out-of-pocket costs of €927 PPPY were reported in an EU5 study. Work productivity losses were also high and reached €10,040 PPPY in patients with M/S AD in the Netherlands. The humanistic burden associated with AD such as sleep disruption, depression, anxiety and impact on education adds further weight to the indirect cost burden.

CONCLUSIONS: The burden of AD on patients, their families, healthcare systems and society is extensive and complex, with effects continuing throughout patients’ lives. When all aspects of costs are considered, it is evident AD is associated with substantial burden across Europe, amounting to estimated annual direct costs of €10 billion and indirect costs of up to €8 billion.