Healthcare visits, patterns of treatment, and related costs in children with controlled and uncontrolled atopic dermatitis in Sweden

Background: Pediatric atopic dermatitis (AD) is a common chronic disease. For assessing treatment outcomes, the concept of controlled and uncontrolled AD has been introduced. Objectives: The aim of the study was to estimate healthcare resource use in terms of visits, treatments and costs in children with controlled and uncontrolled AD. Materials & Methods: The study utilised administrative data and hospital patient records. An algorithm for the identification of patients with controlled and uncontrolled AD was developed, and an assessment of content validity was performed. The study included 8,922 children, aged 0-17 years, diagnosed with AD between 2015 and 2018 in three Swedish regions, treated in primary and specialist care, at regional and university hospitals. Results: The proposed algorithm demonstrated adequate content validity. About 13% of children had uncontrolled AD. In dermatology clinics, most patients with uncontrolled disease were 12-17 years old (39%) and 17% had moderate-to-severe AD; 2% had systemic drug treatment and 7% received UVB treatment. Uncontrolled AD was associated with treatment changes and frequent visits in specialist care over several years compared to controlled disease. The mean annual healthcare cost of a child with AD aged 0-17 years in Sweden was estimated at €4,479.5. There was a statistically significant cost difference (around €4000 annually) between patients with uncontrolled AD and those with controlled disease. Conclusion: AD was associated with high healthcare utilization, especially for children with uncontrolled dis-ease. A high proportion of children with AD might be undertreated, and risk groups, such as adolescents with uncontrolled AD, should be treated more effectively.