Prurigo nodularis, an understudied pruritic inflammatory skin disease, was associated with significantly decreased quality of life and increased individual economic burden, according to findings from a cohort study published in the Journal of the American Academy of Dermatology.

Investigators included adults with a diagnosis of prurigo nodularis (PN) in the study. Patients completed the Ontario Health Utilities Mark 3 (HUI3) survey, a widely-used tool for measuring quality of life (QoL) and performing economic analyses for various chronic diseases. Each patient achieved a score ranging from 0.00 (death) to 1.00 (perfect health). Investigators compared PN patients with control participants using normative data of the general US population collected via the 2002-2003 Joint Canada/United Stated Survey of Health, and excluded respondents with incomplete data regarding HUI3, demographics, and comorbidities.

To assess economic burden, investigators calculated estimates using a discount rate of 3%, and average annual quality-adjusted life years (QALYs) lost 0.33, a willingness-to-pay threshold of $50,000, and PN prevalence of 120,000 individuals in the US.


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There were 36 patients with prurigo nodularis and 4,187 control respondents included in the study. The mean age for patients with prurigo nodularis was 56.3 years, 75% were women, 52.8% were non-Hispanic Black, and 41.7% were non-Hispanic White.

The average overall HUI3 score for patients with prurigo nodularis (0.52) was significantly lower compared with that of control participants (0.86; P <.001). The mean score of 0.52 corresponded to experiencing a “severe disability.” Mean HUI3 scores for patients with prurigo nodularis were similar to those of patients with other debilitating chronic diseases, such as stroke and heart failure, the researchers explained.

Other factors associated with a decreased overall HUI3 score in the multivariable linear regression model included older age, non-Hispanic Black race, Hispanic ethnicity, stroke, coronary artery disease, depression, and arthritis (P <.001 for all). The study authors noted that a similar model found PN associated significantly with decreased functional domains of emotion (P <.001), cognition (P =.001) and pain (P <.001) compared with control participants.

Investigators estimated the individual lifetime economic burden for a patient with prurigo nodularis to be $323,292, and the US societal lifetime economic burden to be $38.80 billion. The average QALY lost per patient was 6.5 years, resulting in 775.901 QALYs lost among the estimated 120,000 patient with PN in the US.

The study was limited by its small sample size and its design, which did not allow for an analysis of PN’s relationship to quality of life over time following treatment.

“Although early studies to develop novel therapies with new potential targets are underway, attempts to improve the QoL in patients with PN will depend on definitive management and treatment strategies,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Whang KA, Le TK, Khanna R, et al. Health-related quality of life and economic burden of prurigo nodularis. J Am Acad Dermatol. 2022;86(3):573-580. doi:10.1016/j.jaad.2021.05.036