Review 2002 © Ashley Publications Ltd ISSN 1465-6566 249 Ashley Publications w w w.ashley-pub.com 1. Introduction 2. Diagnosis 3. Impact of atopic dermatitis 4. Current treatment 5. Pharmacoeconomic considerations 6. Expert opinion: determination of cost-effectiveness 7. Conclusion Monthly Focus: Pharmacoeconomics Pharmacoeconomics of drug therapy for atopic dermatitis Steven R Lamb † & Marius Rademaker † Department of Dermatology, Health Waikato, Hamilton, New Zealand Atopic dermatitis is an increasingly prevalent common childhood disease. While the majority of patients have mild disease, atopic dermatitis can cause considerable distress to patients and their caregivers, with significant social and financial cost to families. With a prevalence of 15 - 20% in Western coun- tries, atopic dermatitis also has a considerable health and societal cost to the community. Many new treatments have been shown to be therapeutically effective, particularly in severe disease, including cyclosporin A (Neoral ® , Novartis AG), interferon, tacrolimus (Fujisawa Pharmaceutical Co. Ltd.) and iv. immunoglobulin. These are expensive when compared to standard treatments like emollients and topical corticosteroids and have significant adverse effects that limit their use. Additional costs related to monitoring are incurred and the long-term safety of these treatments is yet to be determined. However, an advantage over more traditional therapies is their ability to produce benefits even after treatment ceases. Treatments that produce long-term remissions have a greater likelihood of being cost-effective. With monetary constraints on healthcare and the importance governments place on reducing drug costs, economic evaluations are becoming an increasingly important factor for drug acceptance. Those evaluating cost-effectiveness should pay particular atten- tion to the potential reduction in indirect and intangible costs. Unfortunately, there is a dearth of cost-effectiveness studies in atopic eczema and this needs to be addressed with some urgency. Keywords: children, cost-effectiveness, eczema, family stress, immunomodulators, indirect costs Expert Opin. Pharmacother. (2002) 3(3):249-255 1. Introduction Atopic dermatitis is a common chronic inflammatory skin disorder characterised by intensely itchy and erythematous skin with typical morphology and distribution. It is the most common chronic skin disorder in children and affects 15 - 20% of pre- school children in Western countries [1-3]. Generally, two-thirds of children develop symptoms in the first year of life, with another 30% developing them by the age of 5 years [4]. T he tendency is for children to improve as they get older, so prevalence in adults is much lower, ~ 2 - 3% [2]. The onset of atopic dermatitis in adult years can occur and has similar clinical features to those seen in children [5]. Even with resolu- tion in childhood years, adults with a history of atopic dermatitis tend to have a life- long skin sensitivity to irritants that predisposes them to occupational skin disease and particularly hand dermatitis. Despite advances in treatment and a better understanding of the pathogenesis of atopic dermatitis, the incidence of atopic dermatitis is increasing. Several cross sec- tional studies from Europe show that the cumulative incidence of atopic dermatitis has increased in children < 7 years of age. T he frequency of atopic dermatitis has risen from 3% in those born before 1960 to 4 - 8% in those born in the 1960s, 8 - 12% in those born in the 1970s and > 15% in more recent studies [6]. Similar results have been seen in other areas of the world [7,8]. The reason for this is unclear and