Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries
DOI:
https://doi.org/10.2340/actadv.v103.4441Keywords:
alopecia areata, burden of disease, hair loss, health care economics, out-of-pocket costs, treatment providerAbstract
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.
Downloads
References
Shapiro J, Wiseman M, Lui H. Practical management of hair loss. Can Fam Physician 2000; 46: 1469-1477.
Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol 2015; 8: 397-403.
https://doi.org/10.2147/CCID.S53985 DOI: https://doi.org/10.2147/CCID.S53985
Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J Invest Dermatol 2014; 134: 1141-1142.
https://doi.org/10.1038/jid.2013.464 DOI: https://doi.org/10.1038/jid.2013.464
Pratt CH, King LE, Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers 2017; 3: 17011.
https://doi.org/10.1038/nrdp.2017.11 DOI: https://doi.org/10.1038/nrdp.2017.11
Safavi K. Prevalence of alopecia areata in the First National Health and Nutrition Examination Survey. Arch Dermatol 1992; 128: 702.
https://doi.org/10.1001/archderm.1992.01680150136027 DOI: https://doi.org/10.1001/archderm.1992.01680150136027
Hordinsky MK. Overview of alopecia areata. J Investig Dermatol Symp Proc 2013; 16: S13-15.
https://doi.org/10.1038/jidsymp.2013.4 DOI: https://doi.org/10.1038/jidsymp.2013.4
Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol 2012; 166: 916-926.
https://doi.org/10.1111/j.1365-2133.2012.10955.x DOI: https://doi.org/10.1111/j.1365-2133.2012.10955.x
Hunt N, McHale S. The psychological impact of alopecia. BMJ 2005; 331: 951-953.
https://doi.org/10.1136/bmj.331.7522.951 DOI: https://doi.org/10.1136/bmj.331.7522.951
Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatization caused by hair loss - a systematic literature review. J Dtsch Dermatol Ges 2020; 18: 1357-1368.
https://doi.org/10.1111/ddg.14234 DOI: https://doi.org/10.1111/ddg.14234
Quittkat HL, Hartmann AS, Dusing R, Buhlmann U, Vocks S. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry 2019; 10: 864.
https://doi.org/10.3389/fpsyt.2019.00864 DOI: https://doi.org/10.3389/fpsyt.2019.00864
Cartwright T, Endean N, Porter A. Illness perceptions, coping and quality of life in patients with alopecia. Br J Dermatol 2009; 160: 1034-1039.
https://doi.org/10.1111/j.1365-2133.2008.09014.x DOI: https://doi.org/10.1111/j.1365-2133.2008.09014.x
Montgomery K, White C, Thompson A. A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia. BMJ Open 2017; 7: e015468.
https://doi.org/10.1136/bmjopen-2016-015468 DOI: https://doi.org/10.1136/bmjopen-2016-015468
Burns LJ, Mesinkovska N, Kranz D, Ellison A, Senna MM. Cumulative life course impairment of alopecia areata. Int J Trichology 2014; 12: 197-204.
https://doi.org/10.4103/ijt.ijt_99_20 DOI: https://doi.org/10.4103/ijt.ijt_99_20
Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, et al. Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol 2018; 78: 1-12.
https://doi.org/10.1016/j.jaad.2017.04.1141 DOI: https://doi.org/10.1016/j.jaad.2017.04.1141
Tosti A, Bellavista S, Iorizzo M. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol 2006; 55: 438-441.
https://doi.org/10.1016/j.jaad.2006.05.008 DOI: https://doi.org/10.1016/j.jaad.2006.05.008
Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, et al. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol 2018; 78: 15-24.
https://doi.org/10.1016/j.jaad.2017.04.1142 DOI: https://doi.org/10.1016/j.jaad.2017.04.1142
Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33: 850-856.
https://doi.org/10.1111/jdv.15489 DOI: https://doi.org/10.1111/jdv.15489
Marks DH, Penzi LR, Ibler E, Manatis-Lornell A, Hagigeorges D, Yasuda M, et al. The medical and psychosocial associations of alopecia: recognizing hair loss as more than a cosmetic concern. Am J Clin Dermatol 2019; 20: 195-200.
https://doi.org/10.1007/s40257-018-0405-2 DOI: https://doi.org/10.1007/s40257-018-0405-2
Korta DZ, Christiano AM, Bergfeld W, Duvic M, Ellison A, Fu J, et al. Alopecia areata is a medical disease. J Am Acad Dermatol 2018; 78: 832-834.
https://doi.org/10.1016/j.jaad.2017.09.011 DOI: https://doi.org/10.1016/j.jaad.2017.09.011
Kalabokes V, Besta RM. The role of the National Alopecia Areata Foundation in the management of alopecia areata. Dermatologic Therapy 2001; 14: 340-344.
https://doi.org/10.1046/j.1529-8019.2001.01042.x DOI: https://doi.org/10.1046/j.1529-8019.2001.01042.x
Leiner DJ. SoSci Survey (Version 3.2.35) 2018 [Computer software]. Available from: http://www.soscisurvey.com.
Zink AGS, Arents B, Fink-Wagner A, Seitz IA, Mensing U, Wettemann N, et al. Out-of-pocket costs for individuals with atopic eczema: a cross-sectional study in nine European countries. Acta Derm Venereol 2019; 99: 263-267.
https://doi.org/10.2340/00015555-3102 DOI: https://doi.org/10.2340/00015555-3102
Altmeyer P. A. Therapielexikon Dermatologie und Allergologie: Therapie kompakt von A bis Z. Berlin, Heidelberg: Springer Berlin Heidelberg; 2005: 41.
https://doi.org/10.1007/3-540-27648-3 DOI: https://doi.org/10.1007/3-540-27648-3
R Development Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2020.
GKV-Spitzenverband. Fortschreibung der Produktgruppe 34 "Haarersatz" des Hilfsmittelverzeichnisses nach § 139 SGB V. 2018, January 15.
Koblenz S. S9 KR 756/15. juris, Court case 2016, November 16.
LSG-München. Keine Erstattung von Mehrkosten für eine Perückenversorgung. 2021.
Li SJ, Mostaghimi A, Tkachenko E, Huang KP. Association of out-of-pocket health care costs and financial burden for patients with alopecia areata. JAMA Dermatol 2019; 155: 493-494.
https://doi.org/10.1001/jamadermatol.2018.5218 DOI: https://doi.org/10.1001/jamadermatol.2018.5218
Mesinkovska N, King B, Mirmirani P, Ko J, Cassella J. Burden of illness in alopecia areata: a cross-sectional online survey study. J Investig Dermatol Symp Proc 2020; 20: S62-S68.
https://doi.org/10.1016/j.jisp.2020.05.007 DOI: https://doi.org/10.1016/j.jisp.2020.05.007
Senna M, Ko J, Tosti A, Edson-Heredia E, Fenske DC, Ellinwood AK, et al. Alopecia areata treatment patterns, healthcare resource utilization, and comorbidities in the us population using insurance claims. Adv Ther 2021; 38: 4646-4658.
https://doi.org/10.1007/s12325-021-01845-0 DOI: https://doi.org/10.1007/s12325-021-01845-0
Jungen D, Augustin M, Langenbruch A, Zander N, Reich K, Stromer K, et al. Cost-of-illness of psoriasis - results of a German cross-sectional study. J Eur Acad Dermatol Venereol 2018; 32: 174-180.
https://doi.org/10.1111/jdv.14543 DOI: https://doi.org/10.1111/jdv.14543
Huscher D, Merkesdal S, Thiele K, Zeidler H, Schneider M, Zink A, et al. Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany. Ann Rheum Dis 2006; 65: 1175-1183.
https://doi.org/10.1136/ard.2005.046367 DOI: https://doi.org/10.1136/ard.2005.046367
Westhoff G, Listing J, Zink A. [Out-of-pocket medical spending for care in patients with recent onset rheumatoid arthritis]. Z Rheumatol 2004; 63: 414-424.
https://doi.org/10.1007/s00393-004-0650-z DOI: https://doi.org/10.1007/s00393-004-0650-z
Welsh N, Guy A. The lived experience of alopecia areata: a qualitative study. Body Image 2009; 6: 194-200.
https://doi.org/10.1016/j.bodyim.2009.03.004 DOI: https://doi.org/10.1016/j.bodyim.2009.03.004
Cash TF, Price VH, Savin RC. Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. J Am Acad Dermatol 1993; 29: 568-575.
https://doi.org/10.1016/0190-9622(93)70223-G DOI: https://doi.org/10.1016/0190-9622(93)70223-G
Hoffer L, Achdut N, Shvarts S, Segal-Engelchin D. Gender differences in psychosocial outcomes of hair loss resulting from childhood irradiation for tinea capitis. Int J Environ Res Public Health 2021; 18: 7825.
https://doi.org/10.3390/ijerph18157825 DOI: https://doi.org/10.3390/ijerph18157825
Gonul M, Cemil BC, Ayvaz HH, Cankurtaran E, Ergin C, Gurel MS. Comparison of quality of life in patients with androgenetic alopecia and alopecia areata. An Bras Dermatol 2018; 93: 651-658.
https://doi.org/10.1590/abd1806-4841.20186131 DOI: https://doi.org/10.1590/abd1806-4841.20186131
Davey L, Clarke V, Jenkinson E. Living with alopecia areata: an online qualitative survey study. Br J Dermatol 2019; 180: 1377-1389.
https://doi.org/10.1111/bjd.17463 DOI: https://doi.org/10.1111/bjd.17463
Hussain ST, Mostaghimi A, Barr PJ, Brown JR, Joyce C, Huang KP. Utilization of mental health resources and complementary and alternative therapies for alopecia areata: A U.S. survey. Int J Trichology 2017; 9: 160-164.
https://doi.org/10.4103/ijt.ijt_53_17 DOI: https://doi.org/10.4103/ijt.ijt_53_17
Tkachenko E, Okhovat JP, Manjaly P, Huang KP, Senna MM, Mostaghimi A. Complementary and alternative medicine for alopecia areata: A systematic review. J Am Acad Dermatol 2023; 88: 131-143.
https://doi.org/10.1016/j.jaad.2019.12.027 DOI: https://doi.org/10.1016/j.jaad.2019.12.027
van den Biggelaar FJ, Smolders J, Jansen JF. Complementary and alternative medicine in alopecia areata. Am J Clin Dermatol 2010; 11: 11-20.
https://doi.org/10.2165/11530040-000000000-00000 DOI: https://doi.org/10.2165/11530040-000000000-00000
Gilhar A, Keren A, Paus R. JAK inhibitors and alopecia areata. Lancet 2019; 393: 318-319.
https://doi.org/10.1016/S0140-6736(18)32987-8 DOI: https://doi.org/10.1016/S0140-6736(18)32987-8
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Johaina Kullab, Maximilian C. Schielein, Caroline F.Z. Stuhlmann, Linda Tizek, Hannah Wecker, Alphina Kain, Tilo Biedermann, Alexander Zink
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.