Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries


  • Johaina Kullab Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Maximilian C. Schielein Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Caroline F.Z. Stuhlmann The Graduate Center & Hunter College, City University of New York, Department of Psychology, New York, NY, USA; German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Linda Tizek Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Hannah Wecker Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Alphina Kain Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Tilo Biedermann Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
  • Alexander Zink Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany; Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden




alopecia areata, burden of disease, hair loss, health care economics, out-of-pocket costs, treatment provider


Alopecia areata is a common skin disease which is associated with psychosocial and financial burden. No curative therapy exists and, hence, affected persons resort to self-financed cosmetic solutions. However, studies on the economic impact of alopecia areata on individuals are limited. To estimate annual individual out-of-pocket costs in persons with alopecia areata, a cross-sectional study using a standardized online questionnaire was performed in Germany, Austria and Switzerland. A total of 346 individuals (95.1% women, mean age: 38.5 ± 11.6 years) with alopecia areata participated between April and August 2020. Mean additional spending on everyday necessities was 1,248€ per person per year, which was significantly influenced by the duration of the illness, the treatment provider, and disease severity. Hair replacement products and cosmetics accounted for the highest monthly costs, followed by costs for physician visits, hospital treatments, and medication. Most participants (n = 255, 73.7%) were currently not undergoing treatment, due to lack of efficacy, side-effects, costs and acceptance of the disease. Sex differences in expenses were observed, with women having higher expenditures. Alopecia areata-related out-of-pocket costs place a considerable financial burden on affected individuals, are higher compared with those of other chronic diseases, and should be considered in economic assessments of the impact of this disease. 


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How to Cite

Kullab, J., Schielein, M. C., Stuhlmann, C. F., Tizek, L., Wecker, H., Kain, A., Biedermann, T., & Zink, A. (2023). Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries. Acta Dermato-Venereologica, 103, adv00838. https://doi.org/10.2340/actadv.v103.4441

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