Chronic skin diseases have significant impacts on the quality of life (QoL) of the patients, although not life threatening. However, current QoL measurements often do not adequately reflect the actual disease burden of the affected person. Willingness-to-pay (WTP) questionnaire was developed to assess disease burden economically. In this pilot study, we evaluated QoL and WTP in patients with five chronic skin diseases; alopecia areata (AA), atopic dermatitis (AD), chronic urticaria (CU), psoriasis, and vitiligo. QoL was evaluated using the Dermatology Life Quality Index (DLQI) questionnaire, and WTP was assessed from two aspects: monthly WTP for disease control and one-time WTP for disease cure. The body surface area (BSA) of involvement and monthly income of each patient were also collected.
A total of 124 patients (58 males and 66 females; mean age: 41.6 years) were enrolled: 6 for AA, 36 for AD, 27 for CU, 16 for psoriasis, and 39 for vitiligo. The median DLQI score was highest in AD patients (13 for AD, 11 for psoriasis, 9 for AA, 8 for CU and vitiligo). The median Monthly WTP control was highest in vitiligo ($185 for vitiligo, $134 for psoriasis, $92.4 for AD, $84 for AA and CU), and the median one-time WTP cure was also highest in vitiligo ($1891 for vitiligo, $941 for AD and CU, $840 for psoriasis, and $563 for AA). DLQI scores showed a positive correlation with BSA in AD, psoriasis, and vitiligo, however, WTP did not show a positive correlation with BSA in vitiligo, unlike AD and psoriasis.
In conclusion, we demonstrate that WTP was the highest in vitiligo, although it had a lower DLQI score than others. It may imply that DLQI is not a critical indicator of patient’s treatment decision. Furthermore, vitiligo patients with small BSA (<1%) also have high WTP comparable to those with large BSA, unlike AD and psoriasis

Willingness-to-pay of patients with chronic skin diseases: A pilot study