Atopic dermatitis (AD) is a chronic inflammatory skin disease with extensive individual and socioeconomic burden. There are several instruments for measuring skin-specific and generic health-related quality of life (HRQoL) of patients; the latter can also be used for creating inputs for cost-effectiveness analyses in economic evaluations of therapies.
The goal of this study was to assess the HRQoL of adult AD patients in Hungary, to identify the most problematic areas, and to explore how they were affected by the COVID-19 pandemic. We also aimed to compare measurement properties of DLQI, DLQI-R, Skindex-16, and EQ-5D-5L (5L) in terms of ceiling and floor effects as well as convergent and know-group validity. Further, the performance of two generic measures, the EQ-5D-3L (3L) and 5L were compared in AD.
We conducted a multicenter cross-sectional survey involving 218 adult AD patients in Hungary. Participants were asked to complete a survey including the five HRQoL instruments along with sociodemographic and medical questions. Disease severity was measured by EASI, oSCORAD, and IGA, and patients also completed 0-10 VASs for itching and sleep disturbance.
The HRQoL outcomes showed quite severe overall HRQoL impairment; mean DLQI, DLQI-R, and Skindex-16 scores were 13.44, 13.76, and 56.84, while mean 3L and 5L utilities were 0.85 and 0.82, respectively. Problems regarding skin symptoms, pain/discomfort, worrying, fear of persistence/reoccurrence of disease, and social relationships have become more common during the pandemic (p<0.05 for all). Skin-specific instruments outperformed 5L in terms of ceiling effect, convergent and known-group validity. The 5L was superior to 3L regarding ceiling effect, informativity, and convergent validity.
To conclude, patients with AD reported considerable HRQoL impairment in several areas of life, and some problems regarding symptoms and mental health have become even more frequent since the start of the COVID-19 pandemic. Each instrument performed well against validity tests. The skin-specific DLQI, DLQI-R, and Skindex-16 can be recommended for use in clinical practice, and 5L should be preferred over 3L in economic evaluations of AD treatments.
