Suephy C. Chen

The Impact of Pruritus on Quality of Life The Skin Equivalent of Pain

OBJECTIVE To compare the impact of chronic pruritus and chronic pain on quality of life (QoL) using directly elicited health utility scores. DESIGN Cross-sectional study. SETTING Convenience sample of patients attending the Emory Dermatology Clinic, Emory Spine Center, and Emory Center for Pain Management, Atlanta, Georgia. PARTICIPANTS Adult men and women (aged ≥ 18 years) experiencing chronic pain or pruritus for 6 weeks or more. MAIN OUTCOME MEASURES The mean utility score of patients with chronic pruritus was compared with that of patients with chronic pain. A regression analysis was performed to determine the impact of the primary predictor variable-symptom type-on the primary outcome variable-mean utility score (a metric representing the impact on QoL). RESULTS The study included 73 patients with chronic pruritus and 138 patients with chronic pain. The mean (SD) utility among patients with pruritus was 0.87 (0.27) compared with 0.77 (0.31) for patients with pain (P < .01). After symptom severity, duration, and demographic factors were controlled for, only symptom severity (0.03 [P < .05]) and single marital status (-0.12 [P = .02]), but not symptom type (P = .43), remained significant predictors of the mean symptom utility score. CONCLUSIONS Chronic pruritus has a substantial impact on QoL, one that may be comparable to that of pain. The severity of symptoms and the use of support networks are the main factors that determine the degree to which patients are affected by their symptoms. Addressing support networks in addition to developing new therapies may improve the QoL of itchy patients.

Diagnosing and managing cutaneous pigmented lesions : Primary care physicians versus dermatologists

AbstractBACKGROUND: Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists. OBJECTIVE: To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions. DESIGN, PARTICIPANTS: A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003. MEASUREMENTS: Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves. RESULTS: Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions. CONCLUSIONS: Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.

The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity–United States, 2000 to 2006

BACKGROUND Cutaneous melanoma is the most deadly form of skin cancer with more than 8000 deaths per year in the United States. The health burden and economic costs associated with melanoma mortality by race/ethnicity have not been appropriately addressed. OBJECTIVE We sought to quantify the health burden and economic costs associated with melanoma mortality among racial/ethnic groups in the United States. METHODS We used 2000 to 2006 national mortality data and US life tables to estimate the number of deaths, and years of potential life lost (YPLL). Further, we estimated the economic costs of melanoma mortality in terms of productivity losses. All the estimates were stratified by race/ethnicity and sex. RESULTS From 2000 to 2006, we estimated an increase of 13,349 (8.7%) YPLL because of melanoma mortality compared with a 2.8% increase among all malignant cancers across all race/ethnicity. On average, an individual in the United States loses 20.4 years of potential life during their lifetime as a result of melanoma mortality compared with 16.6 years for all malignant cancers. The estimated annual productivity loss attributed to melanoma mortality was

Annual direct and indirect health care costs of chronic idiopathic urticaria: a cost analysis of 50 nonimmunosuppressed patients.

3.5 billion. Our estimates suggest that an individual who died from melanoma in 2000 through 2006 would lose an average of

Economic burden of melanoma in the elderly population: population-based analysis of the Surveillance, Epidemiology, and End Results (SEER)--Medicare data.

413,370 in forgone lifetime earnings. YPLL rates and total productivity losses are much higher among non-Hispanic whites as compared with non-Hispanic blacks and Hispanics. LIMITATIONS The estimated economic costs did not include treatment, morbidity, and intangible costs. CONCLUSIONS We estimated substantial YPLL and productivity losses as a result of melanoma mortality during an individuals lifetime. By examining the burden by race/ethnicity, this study provides useful information to assist policy-makers in making informed resource allocation decisions regarding cutaneous melanoma mortality.

Duration of Voriconazole Exposure: An Independent Risk Factor for Skin Cancer After Lung Transplantation

OBJECTIVE To estimate annual direct and indirect health care costs in patients with chronic idiopathic urticaria (CIU) managed with conventional therapies. DESIGN A cost analysis consisting of a survey-guided and retrospective medical record review of direct and indirect health care costs from a societal perspective in patients with CIU. SETTING The Johns Hopkins University allergy and dermatology ambulatory clinics. PARTICIPANTS Fifty adults with active CIU were recruited in sequential order. Individuals who were taking corticosteroids or other immunosuppressants in the month before enrollment were excluded from the study. MAIN OUTCOME MEASURES We estimated direct health care costs, which included laboratory, medication, outpatient visit, and emergency department and hospital visit costs. We also estimated indirect costs, which included earnings lost owing to travel to outpatient visits and absences from work owing to CIU-related illness. RESULTS Patients with CIU consumed a mean (SD) of

Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

2047 (

Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis: A Randomized Clinical Trial

1483) annually. Because CIU is primarily an outpatient disease, medication costs alone accounted for 62.5% (

Factors Mediating the Impact of Chronic Pruritus on Quality of Life

1280) of the total annual cost. Indirect costs accounted for 15.7% (

Comparison of Diagnostic and Management Sensitivity to Melanoma Between Dermatologists and MelaFind: A Pilot Study

322) of the total costs. CONCLUSIONS High medication costs, followed by total indirect costs, result in the largest economic burden among patients with CIU. High medication costs may place low-income patients at risk for suboptimal treatment and increased burden due to poorly controlled disease. Our estimated total health care costs for CIU are comparable to those of other skin diseases such as vitiligo and bullous disease.