OBJECTIVES: In Germany, patients with chronic hand eczema (CHE) can either be treated within the statutory health insurance system, or if CHE is suspected to be work-related CHE in the system of occupational health insurances. The study objective was to analyze the cost of CHE between both systems. METHODS: The survey was conducted in 24 practices in the statutory health insurance system and 2 specialized centers of the occupational health insurances. Patients with CHE refractory to potent topical treatments were included. Patient characteristics/status and resource use were elicited from patients and physicians. Costs were evaluated from the societal perspective (using insurance specific tariffs). Regression models were employed to compare the direct and indirect costs across both data sets. RESULTS: A total of 223 patients in the statutory health system and 87 patients in the occupational health insurance system were included in this study. The patients’ severity was similar across both samples. The yearly direct and indirect costs per patient are €1742 and €386 in the statutory health insurance system as well as €3309 (€2534 according to statutory health insurance tariff) and €3422 in the occupational health system. The indirect costs are more pronounced among patients with work-related CHE. A comparison of direct and indirect costs reveal higher costs for patients covered by occupational health insurances (p<0.01); however, no cost differences between both systems can be detected after controlling for treatment stage and tariff differences. CONCLUSIONS: Differences in the costs between both systems can be explained by different treatment mixes, as direct costs are similar across treatment stages. As a result of longer absences from work, the indirect costs of patients with work-related CHE are higher. This may lead to the use of more effective and costly treatment strategies in this patient group.