Our study is the first in Argentina and the Latin American region to estimate the economic and social burden of atopic dermatitis (AD) through primary data collection, employing both quantitative and qualitative research methods and incorporating adult and pediatric patients and caregivers. Our findings showed that the average societal annual cost associated with AD was USD 2639 per adult (USD 1842 for mild AD vs. USD 4938 for severe AD, p<0.001) and USD 8683 per pediatric patient (USD 7194 for mild AD vs. USD 14170 for severe AD, p<0.001).

Adults and pediatric adults with AD have spent approximately USD 1000 annually on average out-of-pocket, representing 7% and 9% of the average income, respectively. Both adult patients and caregivers allocated most of their out-of-pocket expenses to topical treatment (around 40% of the total expenditure). Similar findings have been reported in other countries (13,40). These products are categorized as cosmetic items in Argentina and are not covered or discounted. This point is reinforced by our findings, which indicate that the absolute value of out-of-pocket spending does not vary significantly across different types of health coverage. However, a key concern is the financial burden this spending represents relative to income. Caregivers and patients relying on public insurance generally have lower incomes, making these out-of-pocket expenses a significant financial constraint, potentially exacerbating healthcare inequities.

The findings also show that AD imposes a significant burden on labor productivity. Adults with AD lost approximately 5% of their annual working hours due to absenteeism and reported a 33% reduction in productivity due to presenteeism. These results align with previous studies (14,41–45). The qualitative data corroborate these findings, with job stability emerging as a significant concern. Many participants reported difficulties in maintaining employment, securing jobs, and experiencing dismissals due to absenteeism. In addition, caregivers dedicated approximately 5 hours per day to care for affected individuals, representing an annual economic burden of USD 7659 per informal caregiver. This estimate is higher than findings from high-income countries such as Australia, where parents reportedly spent between 2 and 3 hours daily caring for a child with AD (6,46). This difference may be attributed to the limited availability of formal caregiving services in Latin American countries compared to high-income settings, where structured support systems help alleviate caregiving responsibilities for families. The lack of formal caregiving services not only increases the burden on informal caregivers but also exacerbates the financial strain on families. Many caregivers and adults with AD must reduce their working hours or leave their jobs entirely, leading to a significant loss of household income.

The average estimated EQ-5D-5L index for adults with AD in our study was 0.87, aligning with previous research and comparable to indices reported for conditions such as diabetes and arthritis (46,47). Focus groups and interviews further highlighted high levels of anxiety, distress, depression, and insomnia among both patients and caregivers, often due to discomfort and the visible symptoms of AD. The constant vigilance required by caregivers negatively affected their sleep and overall well-being, contributing to chronic stress and fatigue. These findings underscore the broader psychosocial burden associated with AD and highlight the need for comprehensive support systems that address not only medical but also emotional and mental health needs.

Given that AD is not classified as a chronic disease in Argentina—except in the province of Misiones—this classification gap can further limit access to insurance coverage, work-related benefits, and reimbursement for essential treatments. The absence of comprehensive coverage further exacerbates the financial burden on families, reinforcing health inequities and the need for policy reforms to ensure adequate support for individuals living with AD. In September 2023, Misiones enacted the Law of Atopic Dermatitis Care (Provincial Law No. 1700), establishing a comprehensive approach to the disease. This law mandates early detection, diagnosis, and treatment while ensuring multidisciplinary medical care and access to pharmacological and therapeutic interventions. It also promotes telemedicine for remote patient assistance and follow-up, as well as research and education on AD. The law provides coverage for diagnostic tests, psychological and rehabilitative therapies, phototherapy, and essential medications, including biologics and emollients. This initiative could serve as a precedent for national-level policies to improve AD management and access to care in Argentina.

Our study has several strengths, including developing a questionnaire validated by experts. We also employed a qualitative methodology to capture complexities in the relationships between AD patients, caregivers, and the healthcare system. We engaged a skilled qualitative researcher to moderate focus groups, potentially fostering open expression from informants. However, this study has some limitations. While the achieved sample size in the quantitative research exceeded the initial goals, the sample was not randomly selected, potentially affecting the representativeness of the results. Some questions required complex recall, introducing the potential recall bias inherent in time use and cost research. Although standardized questionnaires would have been preferred for measuring disease burden, survey format adherence might not have been absolute because it prioritizes a reduced question count to improve response rates. Adapted questions for presenteeism loss initially yielded higher values, which were corrected through a literature review. The adjusted productivity loss relied on salary estimates from national household surveys, potentially not fully representing the sample.

Additionally, using general quality-of-life questionnaires rather than specific AD questionnaires may not capture particular aspects of the disease, although it allows comparisons with other diseases. Another limitation of this study is the sampling bias inherent in recruiting participants through patient associations, which resulted in an overrepresentation of severe cases and female participants. This bias likely reflects that individuals with more severe disease and women are more proactive in seeking support through such associations, as evidenced by studies on gender differences in healthcare access. To mitigate this bias, cost estimates were adjusted using weighted averages based on severity distributions reported in the literature.

It is important to note that the socioeconomic burden of AD may be underestimated, as this condition is associated with various comorbidities such as allergic rhinitis, pollen allergy, dust allergy, bronchial asthma, and other dermatological diseases (46). Another point to highlight is that many AD adults are also caregivers for children with AD, which could significantly intensify the economic burden. Finally, it is vital to highlight the importance of multidisciplinary work with the community affected by AD and an integrated approach by healthcare professionals.