Quality of life, health-state utilities and willingness to pay in patientswith psoriasis and atopic eczema

Skin diseases have been shown to have a significant adverse impact on the h ealth-related quality of life of patients that may be underestimated by obj ective assessments of clinical severity, The main aim of this study was to measure the health-state utilities on a scale between 0 (dead) and 1 (full health) of patients with psoriasis and atopic eczema. and to measure the wi llingness to pay for a cure for psoriasis and atopic eczema. A second aim w as to analyse how these measures are related to different dimensions of hea lth-related quality of life. as measured by general and disease-specific qu ality of life instruments and a subjective measure of disability activity. This study was based on data from a questionnaire administered to, and inte rviews conducted with, 366 patients with psoriasis and atopic eczema aged 1 7-73 years, attending the dermatology outpatient clinic in Uppsala, Sweden from November 1996 to December 1997, The survey included: a rating scale qu estion, a time trade-off question, a standard gamble question. a dichotomou s choice willingness to pay question, a bidding-game willingness to pay que stion, a generic quality of life instrument (SF-36), a disease-specific qua lity of life instrument (the Dermatology Life Quality Index) and a subjecti ve measure of disease activity (on a visual analogue scale). The mean healt h-state utility was 0.69 (rating scale), 0.88 (time trade-off) and 0.97 (st andard gamble) for patients with psoriasis. The corresponding health-state utilities for patients with atopic eczema were 0.73, 0.93 and 0.98. On aver age, patients were willing to pay between 1253 and 1956 Swedish crowns (SEK ) per month for a psoriasis cure and between SEK 960 and 1083 per month for an atopic eczema cure ($1 = SEK 8.25 and pound 1 = SEK 13.23). The health- state utilities were related to SF-36, the Dermatology Life Quality index a nd disease activity in the expected direction and the correlations were str ongest for rating scale and weakest for standard gamble. The willingness to pay was correlated with the Dermatology Life Quality Index and disease act ivity but not with SF-36, The study indicates that it is feasible to measur e health-state utilities and willingness to pay in this patient population. and the sizeable willingness to pay suggests that skin diseases are associ ated with substantial reductions in quality of life.