Costs Associated With Inpatient Management of Atopic Dermatitis in Paediatric Patients: An Australian Perspective

Atopic dermatitis (AD) is a chronic condition associated with profound impacts on health, education, employment, social interaction and emotional wellbeing. AD in children has a current estimated prevalence of 16% 1, 2. Management of this condition, flares and complications can also be challenging and costly. The costs associated with management, healthcare visits, medications and caregivers' time is substantial; however, less is known regarding the expenditure associated with inpatient admissions on the healthcare system in Australia. With the introduction of dupilumab and upadacitinib in recent years, this has altered the treatment paradigm and allowed for improved management and maintenance of AD. However, these medications remain limited, requiring compassionate application for paediatric patients under 12 years. This single centre retrospective review was conducted to assess the financial impact of paediatric AD on the Australian healthcare system. A single centre, retrospective observational study was completed with review of paediatric inpatient admissions for AD. Inclusion criteria involved patients aged less than 18 years with a diagnosis of “atopic dermatitis”, “dermatitis” or “eczema”. Retrospective data were collected from March 2021 to January 2025 with 282 patients identified. These patients were narrowed to 66 following application of inclusion criteria and review of electronic medical records (EMR). Costing data was not completed for the recent financial year, resulting in a final patient number of 48 patients (n = 48) from between March 2021–June 2024. The mean age of patients was 5. 3 years with a range from 4 months to 17 years. Furthermore, 72. 91% of patients were under 6 years of age as seen below in Table 1. There were 25 male patients and 23 female patients. Patients more commonly presented to the emergency department (27/48) compared to those that were direct ward admissions (21/48). Admissions were more commonly for infection as a complication (28/48) compared to patients admitted for a flare (20/48). The average length of stay was 3 days with a range from 1 to 9 days. The total expenditure over a 39-month period was 394, 133, equating to an annual expenditure of 121, 271 and an average cost per patient of 8211 as highlighted in Table 2. Infection To date, no study in Australia has explored the inpatient financial costs associated with AD in paediatric patients. Data from the Australian Institute of Health and Welfare reveals the annual expenditure for eczema between 2019 and 2020 as 593 million 3. This figure included inpatient and outpatient costs and omitted the number of patients 3. To provide comparison, a Singaporean study found that the economic burden was between USD 6651 for mild AD and USD 14, 335 for severe AD 4. These costs considered out-of-pocket expenses, informal caregiving, medications and appointments in paediatric patients with AD 1. The burden of AD on patients and their families is substantial. The cost of inpatient admissions is alone, demonstrative of the financial burden and does not reflect the costs associated with medications, appointments and financial losses due to carers' leave. While not explored in this study, the impacts on quality of life, sleep, education and emotional wellbeing are also significant 3, 5. Patients with AD are also at increased risk of developmental vulnerability 5. Due to the visibility of disease, patients may experience disease-related stigmatisation, bullying and it can have a profound impact on social development 5. The overall burden of disease on paediatric patients is significant and the role for dupilumab in this population should be considered. Meaningful, rapid improvements in sleep, pruritus and quality of life after 16 weeks of dupilumab were demonstrated in a study of paediatric patients aged 6 months to 5 years with AD and their caregivers 6. While the cost of dupilumab is substantial, cost may be mitigated through improving disease control which could reduce hospital admissions and associated inpatient and outpatient costs. This review aims to capture any presentations to hospital; however, the data is limited by coding accuracy and it is likely that expenditure is underestimated. This study highlights the significant expenditure for paediatric patients requiring hospital admission for AD flares and complications. While this study explored the direct costs on the Australian public healthcare system, it is also important to recognise the associated impacts on a patient and their family. Finally, there is a demonstrated role and significant benefit with treatments such as dupilumab, and improving access to options such as this within the paediatric population should be considered. The authors have nothing to report. The authors have nothing to report. AI has not been used for any component of this study. Ethics approval was received from the Human Research Ethics Committee 24/2/2025. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.