OBJECTIVES

: Treatment of atopic dermatitis (AD) involves application of topical corticosteroids and/or emollient products, multiple times a day. Qualitative research reports the cosmetic properties and burdensome application of these treatments are detrimental to quality of life (QoL). Moderate-to-severe AD can also be treated with systemic therapies which improve the signs and symptoms of AD, and so may reduce the frequency and amount of topical applications. Systemic treatment may, therefore, confer QoL benefits by sign/symptom reduction, and reduced topical requirements. The QoL impact of sign/symptom reduction is widely used to inform clinical and reimbursement decisions, but the impact associated with treatment processes is neglected. This study aimed to quantify the utility and disutility associated with typical AD topical treatment processes.

METHODS

: Seven vignettes describing different skincare regimens for people with moderate-to-severe AD were developed with input from healthcare professionals. 484 respondents from the general population completed time trade-off items for each vignette. Utility values for each regimen, and disutilities associated with the impact of changes to skincare regimens, were calculated. Analysis of variance assessed differences between skincare regimens.

RESULTS

: As skincare regimens increased in intensity (0.7968 for the most intense; 0.9999 for the least), utility values decreased. There were no significant differences between skincare regimens followed by patients with good disease control (0.9862 to 0.9999), however, when compared with those involving corticosteroid and emollient combinations (0.7968 to 0.8835), significant differences were observed (p<0.001). The largest disutilities (0.1521 to 0.1705) were between skincare regimens describing the use of corticosteroid plus emollient and those followed by patients with good disease control.

CONCLUSIONS

: The application of topical treatments has a detrimental effect on QoL, which increases with the duration and frequency of applications. Further research is needed to investigate how health and process utility interact and can both be integrated into medical decision-making.