Process utilities for topical treatment in atopic dermatitis

Jenny Retzler,Adam Smith,Richard Hudson,Matthew Reaney,Raj Rout

doi:10.1007/s11136-019-02174-0

Abstract

PurposeManagement of atopic dermatitis (AD) typically requires application of topical treatments, often multiple times a day. The cosmetic properties and burdensome application of these treatments can be detrimental to quality of life (QoL). Patients who achieve good disease control through use of systemic therapies may reduce the frequency and amount of topical applications, improving QoL. This study aimed to quantify the utility and disutility for topical AD treatment processes.MethodsSeven 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.ResultsAs skincare regimens increased in intensity (0.7968 for the most intense; 0.9999 for the least), utility values decreased. There were no statistically significant differences between skincare regimens followed by patients with good disease control (0.9862 to 0.9999); however, when compared to those involving topical corticosteroids 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 topical corticosteroids plus emollient and those followed by patients with good disease control.ConclusionsThe 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 utilities interact and both can be integrated into medical decision-making.

Highlights

Atopic dermatitis (AD) is an immune-mediated chronic inflammatory skin disease, characterised by persistent and intense itching and redness, and rough, flaking, dry skin with oozing, bleeding and cracking
There was very little difference in utility between skincare regimens likely to be followed by patients with good disease control (#4 to #7), all of which had utility values close to perfect health (0.9862 to 0.9999), while values were lower for skincare regimens likely to be followed by patients using topical corticosteroids (TCS) and emollient treatments (#1 to #3; 0.7968 to 0.8835)
Rather than the traditional iterative elicitation technique, this study requested direct statements of the maximum length of time respondents were willing to trade off. While this approach limits the risk of some of the biases likely to impact iterative approaches [34], it remains unknown whether it introduces other biases, and which direction these may fall in. This is the first study which quantifies the detrimental impact on quality of life (QoL) due to topical treatment for patients with AD and shows that this increases with time spent and number of applications

Summary

Introduction

Atopic dermatitis (AD) is an immune-mediated chronic inflammatory skin disease, characterised by persistent and intense itching and redness, and rough, flaking, dry skin with oozing, bleeding and cracking. For patients with moderate-to-severe AD, disease exacerbation occurs for 4 to 6 months of the year [3], and AD impacts on sleep, physical, emotional and social functioning, and has been associated with depression, all of which detrimentally influence quality of life [4,5,6]. AD management and the quality of life associated with the impact of treatment processes The mainstay of AD management is topical therapy. Moisturisers and emollients are recommended for all patients to improve skin-barrier function and reduce water loss, and topical corticosteroids (TCS) or calcineurin inhibitors are indicated when non-pharmacological interventions alone are insufficient [7]. The application of topical treatments is burdensome, and patients often complain of

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