Economic Burden of Generalized Pustular Psoriasis: A Population-based Register Study in Finland
DOI:
https://doi.org/10.2340/actadv.v106.44671Keywords:
Direct costs, flares, generalized pustular psoriasis, indirect costs, work productivityAbstract
Generalized pustular psoriasis is an inflammatory disease characterized by potentially life-threatening flares. This study assessed the economic burden of generalized pustular psoriasis in Finland by comparing healthcare resource utilization and both direct and indirect costs to population-based and psoriasis vulgaris control groups and between generalized pustular psoriasis patients with and without flares. Patients with ≥ 2 generalized pustular psoriasis diagnoses (ICD-10: L40.1) at a dermatology clinic in secondary healthcare and matched controls were identified during 1996–2019 from national registers. Direct costs were based on primary and secondary healthcare resource utilization and medications, and indirect costs on productivity loss due to sick leaves, disability pensions, and rehabilitation periods. All-cause annual direct costs were 3-fold higher in generalized pustular psoriasis (mean: €10,323) compared with population-based (€3,345; p < 0.001), and psoriasis vulgaris controls (€3,569; p < 0.001). Having flares was associated with 2.7-fold higher direct costs compared with no flares (cost ratio 2.7; 95% CI, 2.1–3.5; p < 0.001), driven by higher hospitalization rates of patients with flares. Flares were also associated with 2.5-fold higher indirect costs (cost ratio 2.5; 95% CI, 1.6–4.0; p < 0.001) compared with no flares. This first comprehensive economic evaluation of generalized pustular psoriasis highlights the substantial economic impact, in particular in patients with flares, and emphasizes costs due to work disability.
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Boehner A, Navarini AA, Eyerich K. Generalized pustular psoriasis: a model disease for specific targeted immunotherapy, systematic review. Exp Dermatol 2018; 27: 1067–1077. DOI: https://doi.org/10.1111/exd.13699
Takeichi T, Akiyama M. Generalized pustular psoriasis: clinical management and update on autoinflammatory aspects. Am J Clin Dermatol 2020; 21: 227–236. DOI: https://doi.org/10.1007/s40257-019-00492-0
Choon SE, Lai NM, Mohammad NA, Nanu NM, Tey KE, Chew SF. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol 2014; 53: 676–684. DOI: https://doi.org/10.1111/ijd.12070
Choon SE, Navarini AA, Pinter A. Clinical course and characteristics of generalized pustular psoriasis. Am J Clin Dermatol 2022; 23: 21–29. DOI: https://doi.org/10.1007/s40257-021-00654-z
Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical, humanistic, and economic burden of palmoplantar pustulosis: a structured review. Expert Rev Clin Immunol 2020; 16: 253–266. DOI: https://doi.org/10.1080/1744666X.2019.1708194
Miyachi H, Konishi T, Kumazawa R, Matsui H, Shimizu S, Fushimi K, et al. Treatments and outcomes of generalized pustular psoriasis: a cohort of 1516 patients in a nationwide inpatient database in Japan. J Am Acad Dermatol 2022; 86: 1266–1274. DOI: https://doi.org/10.1016/j.jaad.2021.06.008
Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Prevalence and incidence of generalized pustular psoriasis in Sweden: a population-based register study. Br J Dermatol 2022; 186: 970–976. DOI: https://doi.org/10.1111/bjd.20966
Viguier M, Bentayeb M, Azzi J, de Pouvourville G, Gloede T, Langellier B, et al. Generalized pustular psoriasis: a nationwide population-based study using the National Health Data System in France. J Eur Acad Dermatol Venereol 2024; 38: 1131–1119. DOI: https://doi.org/10.1111/jdv.19901
Haugaard JH, Thein D, Egeberg A. Prevalence and incidence of patients with generalized pustular psoriasis in Denmark: a nationwide registry-based study. JEADV Clinical Practice 2023; 2: 893–900. DOI: https://doi.org/10.1002/jvc2.233
Frysz M, Patel S, Li M, Griffiths C, Warren R, Ashcroft D. Prevalence, incidence, mortality and healthcare resource use for generalized pustular psoriasis, palmoplantar pustulosis and plaque psoriasis in England: a population-based cohort study. Br J Dermatol 2024; 191: 529–538. DOI: https://doi.org/10.1093/bjd/ljae217
Prinz JC, Choon SE, Griffiths CEM, Merola JF, Morita A, Ashcroft DM, et al. Prevalence, comorbidities and mortality of generalized pustular psoriasis: a literature review. J Eur Acad Dermatol Venereol 2023; 37: 256–273. DOI: https://doi.org/10.1111/jdv.18720
Ericson O, Löfvendahl S, Norlin JM, Gyllensvärd H, Schmitt-Egenolf M. Mortality in generalized pustular psoriasis: a population-based national register study. J Am Acad Dermatol 2023; 89: 616–629. DOI: https://doi.org/10.1016/j.jaad.2023.04.066
Sugiura K, Takemoto A, Yamaguchi M, Takahashi H, Shoda Y, Mitsuma T, et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin-36 receptor antagonist. J Invest Dermatol 2013; 133: 2514–2521. DOI: https://doi.org/10.1038/jid.2013.230
Bachelez H, Choon SE, Marrakchi S, Burden AD, Tsai TF, Morita A, et al. Trial of spesolimab for generalized pustular psoriasis. N Engl J Med 2021; 385: 2431–2440. DOI: https://doi.org/10.1056/NEJMoa2111563
Krueger J, Puig L, Thaçi D. Treatment options and goals for patients with generalized pustular psoriasis. Am J Clin Dermatol 2022; 23: 51–64. DOI: https://doi.org/10.1007/s40257-021-00658-9
Navarini AA, Prinz JC, Morita A, Tsai TF, Viguier MA, Li L, et al. Spesolimab improves patient-reported outcomes in patients with generalized pustular psoriasis: results from the Effisayil 1 study. J Eur Acad Dermatol Venereol 2023; 37: 730–736. DOI: https://doi.org/10.1111/jdv.18820
Elewski BE, Lebwohl MG, Anadkat MJ, Barker J, Ghoreschi K, Imafuku S, et al. Rapid and sustained improvements in Generalized Pustular Psoriasis Physician Global Assessment scores with spesolimab for treatment of generalized pustular psoriasis flares in the randomized, placebo-controlled Effisayil 1 study. J Am Acad Dermatol 2023; 89: 36–44. DOI: https://doi.org/10.1016/j.jaad.2023.02.040
Morita A, Strober B, Burden AD, Choon SE, Anadkat MJ, Marrakchi S, et al. Efficacy and safety of subcutaneous spesolimab for the prevention of generalised pustular psoriasis flares (Effisayil 2): an international, multicentre, randomised, placebo-controlled trial. Lancet 2023; 402: 1541–1551. DOI: https://doi.org/10.1016/S0140-6736(23)01378-8
Warren RB, Reich A, Kaszuba A, Placek W, Griffiths CEM, Zhou J, et al. Imsidolimab, an anti-interleukin-36 receptor monoclonal antibody, for the treatment of generalized pustular psoriasis: results from the phase II GALLOP trial. Br J Dermatol 2023; 189: 161–169. DOI: https://doi.org/10.1093/bjd/ljad083
Hanna ML, Singer D, Valdecantos WC. Economic burden of generalized pustular psoriasis and palmoplantar pustulosis in the United States. Curr Med Res Opin 2021; 37: 735–742. DOI: https://doi.org/10.1080/03007995.2021.1894108
Tarride JE, Prajapati VH, Lynde C, Blackhouse G. The burden of palmoplantar pustulosis: aa Canadian population-based study of inpatient care, emergency departments, and outpatient clinics. JAAD Int 2023; 12: 151–159. DOI: https://doi.org/10.1016/j.jdin.2023.04.002
Morita A, Kotowsky N, Gao R, Shimizu R, Okubo Y. Patient characteristics and burden of disease in Japanese patients with generalized pustular psoriasis: results from the Medical Data Vision claims database. J Dermatol 2021; 48: 1463–1473. DOI: https://doi.org/10.1111/1346-8138.16022
Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Economic burden of generalized pustular psoriasis in Sweden: a population-based register study. Psoriasis 2022; 12: 89–98. DOI: https://doi.org/10.2147/PTT.S359011
Wolf P, Ceovic R, Conrad C, Falkensteiner K, Graier T, Kołt-Kamińska M, et al. Characteristics and management of generalized pustular psoriasis (GPP): experience from the Central and Eastern Europe (CEE) GPP Expert Network. J Eur Acad Dermatol Venereol 2024; 38: 1531–1542. DOI: https://doi.org/10.1111/jdv.19808
Löfvendahl S, Norlin JM, Ericson O, Hanno M, Schmitt-Egenolf M. Prolonged sick leave before and after diagnosis of generalized pustular psoriasis: a Swedish population-based register study. Acta Derm Venereol 2023; 103: adv6497. DOI: https://doi.org/10.2340/actadv.v103.6497
Hanna M, Singer D, Tang W, Zhou J, Macaulay D, Valdecantos WC, et al. PRO41 indirect burden of illness in patients with generalized pustular psoriasis in the United States. Value in Health 2020; 23: S696–697. DOI: https://doi.org/10.1016/j.jval.2020.08.1777
Zema CL, Valdecantos WC, Weiss J, Krebs B, Menter AM. Understanding flares in patients with generalized pustular psoriasis documented in US Electronic Health Records. JAMA Dermatol 2022; 158: 1142–1148. DOI: https://doi.org/10.1001/jamadermatol.2022.3142
Kapiainen S, Väisänen A, Haula T. Terveyden-ja sosiaalihuollon yksikkökustannukset Suomessa vuonna 2011 [Internet] 2014. Available from: http: //urn.fi/URN: ISBN: 978-952-302-079-5
Hanly P, Timmons A, Walsh PM, Sharp L. Breast and prostate cancer productivity costs: a comparison of the human capital approach and the friction cost approach. Value in Health 2012; 15: 429–436. DOI: https://doi.org/10.1016/j.jval.2011.12.012
Tilastokeskus. Tulorekisterin palkat ja palkkiotulot kuukausittain sukupuolen ja ikäryhmän mukaan muuttujina Kuukausi, Sukupuoli, Tulonsaajaryhmä, Ikäluokka, Tuloluokka, Tuloerä ja Tiedot [Internet]. PxWeb [cited 2024 Jan 15]. Available from: https://pxdata.stat.fi:443/PxWebPxWeb/pxweb/fi/Kokeelliset_tilastot/Kokeelliset_tilastot__trek/koeti_trek_pxt_131w_fi.px/
Kuo CL, Duan Y, Grady J. Unconditional or conditional logistic regression model for age-matched case-control data? Front Public Health 2018; 6: 57. DOI: https://doi.org/10.3389/fpubh.2018.00057
Koivusalo M, Teitsma X, Mehtälä J, Vesikansa A, Capion SC, Airaksinen L, et al. Epidemiology, clinical characteristics, flares and mortality of generalized pustular psoriasis: a nationwide register study in Finland. Skin Health and Disease 2025; 5: 432–442. DOI: https://doi.org/10.1093/skinhd/vzaf076
Tarride JE, Prajapati VH, Lynde C, Blackhouse G. The burden associated with generalized pustular psoriasis: a Canadian population-based study of inpatient care, emergency departments, and hospital- or community-based outpatient clinics. JAAD Int 2023; 12: 90–98. DOI: https://doi.org/10.1016/j.jdin.2023.03.012
Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol 2014; 20: 327. DOI: https://doi.org/10.3350/cmh.2014.20.4.327
Yang G, Cintina I, Pariser A, Oehrlein E, Sullivan J, Kennedy A. The national economic burden of rare disease in the United States in 2019. Orphanet J Rare Dis 2022; 17: 163. DOI: https://doi.org/10.1186/s13023-022-02299-5
Laaksonen M, Gould R. Return to work after temporary disability pension in Finland. J Occup Rehabil 2015; 25: 471–480. DOI: https://doi.org/10.1007/s10926-014-9554-1
Fujita H, Gooderham M, Romiti R. Diagnosis of generalized pustular psoriasis. Am J Clin Dermatol 2022; 23: 31–38. DOI: https://doi.org/10.1007/s40257-021-00652-1
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Copyright (c) 2026 Xavier Teitsma, Laura Huilaja, Mirkka Koivusalo, Juha Mehtälä, Aino Vesikansa, Bregt Kappelhoff, Maria Grönman, Jarmo Kaukua, Pauliina Nuutinen, Rafael Pasternack

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