Alexandra Metsini

Atopic dermatitis (AD) is associated with impaired health-related quality of life (HRQoL), especially in moderate-to-severe disease. The Dermatology Life Quality Index (DLQI) is the most widely used dermatology-specific measure, whereas the EuroQol Five-Dimension, Five-Level questionnaire (EQ-5D-5L), a generic preference-based instrument, assesses health status across diseases. This study examined the relationship between DLQI and EQ-5D-5L in Swedish adults with ADatopic dermatitis and developed a mapping model to estimate EQ-5D-5L utilities from DLQI scores. In this cross-sectional study, 112 Swedish adults with self-reported physician-diagnosed ADatopic dermatitis, recruited through the Swedish Asthma and Allergy Patient Association, completed both questionnaires. DLQI scores correlated strongly and negatively with EQ-5D-5L index values (r=−-0.64, p<0.001). Each 5-point increase in DLQI corresponded on average to a 0.07 decrease in EQ-5D-5L utility. A fractional logit regression model including covariates age, sex, and disease severity, showed good calibration and explained 27 % of the variance in EQ-5D-5L values. These findings demonstrate that DLQI scores meaningfully reflect generic HRQoL among adults with ADatopic dermatitis and can be used to estimate EQ-5D-5L utilities when preference-based data are unavailable. The results enhance understanding of how DLQI relaterelates to overall health status and support the application of DLQI-derived utilities in cost-effectiveness analyses and health technology assessments.

Atopic dermatitis (AD) is a chronic skin disease associated with impaired quality of life. Evidence from Sweden on out-of-pocket expenses and productivity losses remains limited. This study assessed the burden of AD among adults in relation to health-related quality of life (HRQoL), work productivity, activity impairment, willingness to pay for symptom relief, economic outcomes, considering comorbid asthma, allergies, depression and anxiety. A cross-sectional survey was conducted between 2024 and 2025 among 220 members of the Swedish Asthma and Allergy Patient Association. Validated instruments included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensions, five-levels instrument (EQ-5D-5L), Patient Benefit Index, and Work Productivity and Activity Impairment questionnaire. Descriptive and regression analyses were performed. Respondents (89.8% female; mean age 43 years) reported moderate HRQoL impairment (mean DLQI 10.1). DLQI and EQ-5D-5L were worse among those with allergic or non-atopic comorbidities but did not differ by asthma status. Mean annual out-of-pocket costs and productivity losses were €900 (95% CI: 401.1–1,758.4) and €1,972 (95% CI: 1,198.7–2,828.0), respectively. Itch intensity and activity impairment were associated with lower HRQoL and higher costs. AD is related to worsened work and activity functioning and high economic burden, suggesting the need for improved support and management strategies for affected adults.

Pediatric atopic dermatitis (AD) is a common chronic disease. For assessing treatment outcomes, the concept of controlled and uncontrolled AD has been introduced. 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. 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. 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. AD was associated with high healthcare utilization, especially for children with uncontrolled disease. A high proportion of children with AD might be undertreated, and risk groups, such as adolescents with uncontrolled AD, should be treated more effectively.

Background: Unpaid domestic work has been found to be negatively associated with mental health, especially among women, in previous studies but the measures of domestic work vary. The aim of this study was to elucidate the association between time spent in domestic work and mental health in the general population. Method: The study is based on 14,184 women and men aged 30–69 years who responded to a survey questionnaire in Central Sweden in 2017 (overall response rate: 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between hours spent in domestic work and depressive symptoms and self-reported diagnosed depression, respectively. Results: In total, 26.7% of the respondents reported depressive symptoms and 8.8% reported diagnosed depression. No independent associations between hours spent in domestic work and depressive symptoms were found. Among women, the lowest prevalence of depression was found among those who spend 11–30 h per week in domestic work. Among men, the prevalence of self-reported diagnosed depression was highest among those who spend 0–2 h per week in domestic work, but no other statistically significant associations between time spent in domestic work and depression were found. In addition, a strong dose–response relationship was found between experiencing domestic work as burdensome and both depressive symptoms and self-reported diagnosed depression among women and men. Conclusion: Investigating time spent in unpaid domestic work may not be sufficient to assess the association between exposure to domestic work and mental health. Conversely, strain in domestic work may be a more important factor contributing to the prevalence of poor mental health in the general population.

Background: Atopic dermatitis (AD) is a common inflammatory skin disease while the economic burden of AD by severity is not adequately understood.Objective: To estimate the societal economic burden and to identify cost determinants of AD.Methods: In this population‐based, controlled cohort study in Sweden, patients with AD were identified through diagnosis codes in primary or secondary care or by dispensed medications using administrative healthcare registers. A reference cohort without AD was randomly selected from the general population. Healthcare costs (primary/secondary care visits and dispensed medication) and indirect costs (care for sick children and long‐term sick leave for adults) were calculated annually. AD patients were stratified by age (paediatric [age < 12], adolescent [12 ≤ age < 18] or adult [age ≥ 18]), and severity (mild‐to‐moderate [M2M] or severe AD) and matched to the reference cohort.Results: Compared with controls, the annual mean per‐patient direct healthcare costs in the first year following diagnosis were €941 and €1259 higher in paediatric patients with M2M and severe AD, respectively. In the first year following diagnosis, the mean indirect cost for care of sick children was €69 and €78 higher per patient in M2M and severe AD, respectively. In adolescents with M2M and severe AD, direct healthcare costs were €816 and €1260 higher, respectively. In adults, healthcare costs were €1583 and €2963 higher in patients with M2M and severe AD, respectively and indirect costs were €148 and €263 higher compared with controls. Management of comorbid medical conditions was an important driver of incremental healthcare costs. Total incremental societal economic burden for AD was €351 and €96 million higher in patients with M2M and severe AD, respectively, compared to controls.Conclusion: AD is associated with a significant societal economic burden primarily driven by the cost burden of M2M AD due to the high prevalence of this population. Regardless of severity level, management of non‐AD comorbidities is a major driver of total costs.

Background: In contrast to paid work, few studies have investigated the association between unpaid domestic work and mental health. The aim of this study was to investigate the association between domestic work and self-reported diagnosed depression and to estimate related costs in a general population. Method: The study is based on women (N = 7981) and men (N = 6203) aged 30–69 years who responded to a survey questionnaire in Mid-Sweden in 2017 (overall response rate 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between domestic work and depression. The estimation of direct and indirect costs was based on the calculation of population attributable risks, the literature, and administrative data. Results: In total, 25% of the women and 14% of the men spent more than 20 h a week on domestic work, and 57% of the women and 39% of the men experienced domestic work sometimes or more often as burdensome. A strong independent association between experiencing domestic work as burdensome and depression was observed both in women and men. The total cost of depression possibly related to burdensome domestic work was estimated up to EUR 135.1 million (min EUR 20.7 million–max EUR 21.4 billion) of the total EUR 286.4 million per year in Mid-Sweden. Conclusions: The association between experiencing domestic work as burdensome and depression was strong among both women and men and was not restricted to employed persons or to parents with children. Even though the cross-sectional design does not allow one to assess the direction of the association between domestic work and depression, and longitudinal studies are needed, the results imply that strain in domestic work should be taken into account when considering factors that contribute to the prevalence of depression in the general population and its high societal costs.