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BACKGROUND: Hand dermatitis has a large impact on society as a whole. OBJECTIVES: To evaluate the cost-effectiveness of integrated, multidisciplinary care as compared with usual care (UC) for patients with moderate to severe chronic hand dermatitis after 52 weeks. METHODS: Patients (n = 196) visiting the dermatology department at one of the participating hospitals for hand dermatitis were randomized to integrated care (IC) or UC. IC was provided by a multidisciplinary team, and integrated clinical and occupational care to optimize treatment of hand dermatitis. Effect outcomes were clinical assessment of hand dermatitis with the Hand Eczema Severity Index (HECSI), and disease-specific quality of life, work performance and quality-adjusted life-years with the EQ-5D. Incremental cost-effectiveness ratios (ICERs) were calculated. The ICER indicates the additional investment needed to gain one unit of effect. RESULTS: The HECSI difference between both groups after 52 weeks was 8.7 (standard error 5.3, 95% confidence interval -1.8-18.9). No differences were found on secondary outcome measures. Mean total costs with IC (euro3613; SD 798) were significantly higher than with UC (euro1576, SD 430). The ICER for improvement in HECSI score was - 247. IC was not considered to be cost-effective as compared with UC. The probability that IC was cost-effective was 90% at a ceiling ratio of euro1500 per additional point improvement in HECSI score. CONCLUSION: Integrated care was neither cost-effective, nor effective after 12 months follow-up, in contrast to our findings after 6 months. Decision makers should decide whether the clinical benefits of integrated care on the short term outweigh the higher costs compared to usual care.

BACKGROUND: Healthcare professionals have a high risk of developing hand eczema. Hand eczema can interfere with their work. OBJECTIVES: To investigate the prevalence of self-reported hand eczema among healthcare professionals in the Netherlands, and to investigate absenteeism and presenteeism resulting from hand eczema. METHODS: A questionnaire-based observational study was performed. Participants were recruited from hospitals and nursing homes in the Netherlands. The study population consisted of 1232 healthcare professionals. We used the NOSQ-2002 to measure hand eczema and the PRODISQ for absenteeism and presenteeism. RESULTS: The 1-year prevalence of hand eczema among healthcare professionals was 12%. Among all participants, 47% reported symptoms related to hand eczema. Sick leave resulting from hand eczema was reported by 0.3% of healthcare professionals in general, and by 1.7% of healthcare professionals with hand eczema. In the group with hand eczema, 3.1% reported a large effect on presenteeism. CONCLUSIONS: The 1-year prevalence of hand eczema among healthcare professionals in the Netherlands is low, but the prevalence of symptoms related to hand eczema is quite high. Hand eczema seems to have little impact on work in terms of absenteeism and presenteeism.

Hand dermatitis has a large impact on society as a whole.To evaluate the cost-effectiveness of integrated, multidisciplinary care as compared with usual care (UC) for patients with moderate to severe chronic hand dermatitis after 52 weeks.Patients (n = 196) visiting the dermatology department at one of the participating hospitals for hand dermatitis were randomized to integrated care (IC) or UC. IC was provided by a multidisciplinary team, and integrated clinical and occupational care to optimize treatment of hand dermatitis. Effect outcomes were clinical assessment of hand dermatitis with the Hand Eczema Severity Index (HECSI), and disease-specific quality of life, work performance and quality-adjusted life-years with the EQ-5D. Incremental cost-effectiveness ratios (ICERs) were calculated. The ICER indicates the additional investment needed to gain one unit of effect.The HECSI difference between both groups after 52 weeks was 8.7 (standard error 5.3, 95% confidence interval -1.8-18.9). No differences were found on secondary outcome measures. Mean total costs with IC (€ 3613; SD 798) were significantly higher than with UC (€ 1576, SD 430). The ICER for improvement in HECSI score was -247. IC was not considered to be cost-effective as compared with UC. The probability that IC was cost-effective was 90% at a ceiling ratio of € 1500 per additional point improvement in HECSI score.Integrated care was neither cost-effective, nor effective after 12 months follow-up, in contrast to our findings after 6 months. Decision makers should decide whether the clinical benefits of integrated care on the short term outweigh the higher costs compared to usual care.

Healthcare professionals have a high risk of developing hand eczema. Hand eczema can interfere with their work.To investigate the prevalence of self-reported hand eczema among healthcare professionals in the Netherlands, and to investigate absenteeism and presenteeism resulting from hand eczema.A questionnaire-based observational study was performed. Participants were recruited from hospitals and nursing homes in the Netherlands. The study population consisted of 1232 healthcare professionals. We used the NOSQ-2002 to measure hand eczema and the PRODISQ for absenteeism and presenteeism.The 1-year prevalence of hand eczema among healthcare professionals was 12%. Among all participants, 47% reported symptoms related to hand eczema. Sick leave resulting from hand eczema was reported by 0.3% of healthcare professionals in general, and by 1.7% of healthcare professionals with hand eczema. In the group with hand eczema, 3.1% reported a large effect on presenteeism.The 1-year prevalence of hand eczema among healthcare professionals in the Netherlands is low, but the prevalence of symptoms related to hand eczema is quite high. Hand eczema seems to have little impact on work in terms of absenteeism and presenteeism.