OBJECTIVES: Prurigo nodularis (PN) is an inflammatory skin disease characterized by multiple cutaneous nodules and intense itch that contribute to significant patient burden. To date, there are no approved systemic therapies for PN. The economic impact of PN is under-reported, with limited estimates available on healthcare resource use (HCRU) and costs. This systematic literature review (SLR) examined the published evidence on economic evaluations, utility estimates, HCRU and costs in PN.
METHODS: The SLR was conducted in July 2021, using Embase, MEDLINE, Cochrane-library, Centre for Reviews and Dissemination, National Health Service Economic Evaluation Database, School of Health and Related Research Health Utilities Database and EconL. Abstracts from conference proceedings were searched manually (from 2019-2021).
RESULTS: Thirteen PN economic impact studies were identified (n=1, economic evaluation [US], n=3, utility data [2, US; 1, Denmark], n=12, HCRU and costs [10, US; 2, Europe]); studies could be included in multiple categories. One study on quality-adjusted life-year loss in the US was identified and reported life-time costs of $323,292/patient and quality-adjusted life-year loss of 6.5 years/patient versus general population. All utility studies demonstrated a negative impact on quality-of-life; one study showed greater deterioration in black PN patients versus white patients (Health Utilities Index Mark 3 scores: coefficient -0.49, 95% CI [-0.98;-0.01]). In the US, total annual direct costs for PN (year 2016-2017) varied according to the follow-up time and comorbidities (range:$8,240-32,433/patient/year). Hospitalization duration (range: 3.9-16.4 days) and physician visits (range: 0.49-2.01 visits/patient/year) were greater in PN patients compared with general populations. The productivity loss (absenteeism/retirement) was reported in >25% patients in Europe.
CONCLUSIONS: High-quality economic studies in PN are scarce, with more data available for the US than Europe. PN was associated with a high financial burden and poor quality-of-life, with a disproportionate impact on black subgroup. Overall, these data emphasize the need for effective treatments.
