The Economic Burden of Alopecia Areata: Evidence from a Survey in Norway and Sweden
DOI:
https://doi.org/10.2340/actadv.v106.adv-2025-0114Keywords:
alopecia areata, resource use, societal costs, survey, Norway, SwedenAbstract
While international studies have assessed the economic burden of alopecia areata (AA), its societal costs have not been quantified in a Nordic context. We conducted a cross-sectional survey among adults with self-reported AA in Norway and Sweden, recruited via a patient organization and social media. A total of 329 respondents (263 from Norway, 66 from Sweden) provided information on demographics, disease characteristics, healthcare utilization, out-of-pocket expenses, productivity losses and treatment satisfaction. Costs were estimated from a societal perspective, combining direct medical, direct non-medical and indirect costs from reduced productivity. The annual mean total cost of AA was €7,677 in Norway and €12,582 in Sweden, with indirect costs (61–64% of the total) as the largest component, primarily driven by presenteeism and long-term sick leave. A notable finding is the significant out-of-pocket costs. In Norway, individuals paid about 65% of direct costs themselves, in Sweden about 50%. Dissatisfaction with treatment and healthcare support was widespread. Only a minority received systemic therapies, and treatment frequency with Janus kinase inhibitors was low, likely due to lack of reimbursement. AA imposes a considerable societal and individual economic burden in Norway and Sweden, underscoring the need for better therapies, healthcare support and policy recognition of its impact.
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Andersen YMF, Nymand L, DeLozier AM, Burge R, Edson-Heredia E, Egeberg A. Patient characteristics and disease burden of alopecia areata in the Danish skin Cohort. BMJ Open 2022; 12: e053137. DOI: https://doi.org/10.1136/bmjopen-2021-053137
Jeon JJ, Jung SW, Kim YH, Parisi R, Lee JY, Kim MH, et al. Global, regional and national epidemiology of alopecia areata: a systematic review and modelling study. Br J Dermatol 2024; 191: 325–335. DOI: https://doi.org/10.1093/bjd/ljae058
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. DOI: https://doi.org/10.1038/jid.2013.464
Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol 2015; 8: 397–403. DOI: https://doi.org/10.2147/CCID.S53985
Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med 2021; 21: 215–230. DOI: https://doi.org/10.1007/s10238-020-00673-w
Chernyshov PV, Tomas-Aragones L, Finlay AY, Manolache L, Marron SE, Sampogna F, et al. Quality of life measurement in alopecia areata. Position statement of the European academy of dermatology and venereology task force on quality of life and patient oriented outcomes. J Eur Acad Dermatol Venereol 2021; 35: 1614–1621. DOI: https://doi.org/10.1111/jdv.17370
Mandelin JM, Rehn L, Kosunen M, Väkeväinen M, Rannanpää S. The diverse experiences and challenges of individuals with alopecia areata: survey results from Finland. J Patient Exp 2025; 12: 23743735251346633. DOI: https://doi.org/10.1177/23743735251346633
Rencz F, Gulácsi L, Péntek M, Wikonkál N, Baji P, Brodszky V. Alopecia areata and health-related quality of life: a systematic review and meta-analysis. Br J Dermatol 2016; 175: 561–571. DOI: https://doi.org/10.1111/bjd.14497
Vestergaard C, Carrillo D de la R, Mandla R, Frøstrup AG, Gren ST, Vänni P, et al. Alopecia areata: impact on patients’ quality of life and disease perception: a survey-based study. Acta Derm Venereol 2025; 105: adv43318. DOI: https://doi.org/10.2340/actadv.v105.43318
Alhanshali L, Buontempo MG, Lo Sicco KI, Shapiro J. Alopecia areata: burden of disease, approach to treatment, and current unmet needs. Clin Cosmet Investig Dermatol 2023; 16: 803– 820. DOI: https://doi.org/10.2147/CCID.S376096
Rudnicka L, Arenbergerova M, Grimalt R, Ioannides D, Katoulis AC, Lazaridou E, et al. European expert consensus statement on the systemic treatment of alopecia areata. J Eur Acad Dermatol Venereol 2024; 38: 687–694. DOI: https://doi.org/10.1111/jdv.19768
Dental and Pharmaceutical Benefits Agency. Olumiant ingår inte i högkostnadsskyddet vid Alopecia Areata [Olumiant is not covered under the reimbursement scheme for Alopecia Areata]. [cited 2025 April 15]. Available from: https://www.tlv.se/beslut/beslut-lakemedel/avslag-och-uteslutningar/arkiv/2023-06-16-olumiant-ingar-inte-i-hogkostnadsskyddet-vidalopecia-areata.html?query=olumiant DOI: https://doi.org/10.25130/tjphs.2020.15.1.3.16.24
Dental and Pharmaceutical Benefits Agency. Litfulo ingår inte i högkostnadsskyddet vid Alopecia Areata [Litfulo is not covered under the reimbursement scheme for Alopecia Areata]. [cited 2025 April 13]. Available from: https://www.tlv.se/beslut/beslut-lakemedel/avslag-och-uteslutningar/arkiv/2025-03-25-litfulo-ingar-inte-i-lakemedelsformanerna.html?query=Litfulo
Nye metoder. Ritlecitinib (Litfulo). [cited 2024 December 10]. Available from: https://www.nyemetoder.no/metoder/ritlecitinib/
Nye metoder. Baricitinib (Olumiant). . [cited 2025 February 18]. Available from: https://www.nyemetoder.no/metoder/baricitinib-olumiant-indikasjon-v/
Kullab J, Schielein MC, Stuhlmann CFZ, Tizek L, Wecker H, Kain A, et al. Out-of-pocket costs in alopecia areata: a crosssectional study in german-speaking countries. Acta Derm Venereol 2023; 103: adv00838. DOI: https://doi.org/10.2340/actadv.v103.4441
Fenske DC, Ding Y, Morrow P, Smith SG, Silver MK, Moynihan M, et al. Comparing the burden of illness in patients with alopecia areata vs atopic dermatitis in the US population from a payer perspective. J Manag Care Spec Pharm 2023; 29: 409–419. DOI: https://doi.org/10.18553/jmcp.2023.29.4.409
Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The association of alopecia areata-related emotional symptoms with work productivity and daily activity among patients with alopecia areata. Dermatol Ther (Heidelb) 2023; 13: 285–298. DOI: https://doi.org/10.1007/s13555-022-00864-1
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. DOI: https://doi.org/10.1016/j.jisp.2020.05.007
Mostaghimi A, Gandhi K, Done N, Ray M, Gao W, Carley C, et al. All-cause health care resource utilization and costs among adults with alopecia areata: a retrospective claims database study in the United States. J Manag Care Spec Pharm 2022; 28: 426–434. DOI: https://doi.org/10.18553/jmcp.2022.28.4.426
Perrone V, Sabatino S, Avitabile A, Dovizio M, Leogrande M, Degli Esposti L. Real world evidence: patients with alopecia areata in Italy. Ital J Dermatol Venerol 2024; 159: 182–189. DOI: https://doi.org/10.23736/S2784-8671.24.07785-5
Zucchelli F, Harries M, Messenger A, Montgomery K. Establishing the financial burden of alopecia areata and its predictors. Skin Health Dis 2024; 4: e301. DOI: https://doi.org/10.1002/ski2.301
Mostaghimi A, Xenakis J, Meche A, Smith TW, Gruben D, Sikirica V. Economic burden and healthcare resource use of alopecia areata in an insured population in the USA. Dermatol Ther 2022; 12: 1027–1040. DOI: https://doi.org/10.1007/s13555-022-00710-4
Ohyama M, Kamei K, Yuasa A, Anderson P, Milligan G, Sakaki- Yumoto M. Economic burden of alopecia areata: a study of direct and indirect cost in Japan using real-world data. J Dermatol 2023; 50: 1246–1254. DOI: https://doi.org/10.1111/1346-8138.16888
Southern Healthcare Region in Sweden. Regional pricing and reimbursement schemes in the Southern Healthcare Region. [cited 2024 December 5]. Available from: https://sodrasjukvardsregionen.se/prislista-foregaende-ar-2024/
Den norske legeforeningen. Normaltariffen. [cited 2024 October 29]. Available from: https://normaltariffen.no/
LOVDATA. Takster for sykepleiere i primærhelseteam med honorarmodellen [Rates for nurses in primary care teams under the fee-for-service model]. [cited 2024 October 28]. Available from: https://lovdata.no/dokument/LTI/forskrift/2022-06-29-1243
Helfo. Utvalde takstar for psykolog [Selected rates for psychologist]. [cited 2024 October 28]. Available from: https://www.helfo.no/Psykolog/regelverk-og-takster-forpsykolog/ofte-brukte-takstar-for-psykolog#takstgruppecbehandlingmedpsykologa
Western Healthcare Region in Sweden. Out-of-county prices for healthcare services — Western Healthcare Region. Out-of-county prices for healthcare services — Western Healthcare Region. [cited 2024 December 5]. Available from: https://www.vgregion.se/politik/politiskorganisation/namnder-och-styrelser-for-halso--och-sjukvard/samverkansnamnden/
The Swedish Association of the Pharmaceutical Industry. Farmaceutiska Specialiteter i Sverige (FASS) [Pharmaceutical Specialties in Sweden]. [cited 2024 October 15]. Available from: https://www.fass.se/LIF/startpage
The Norwegian Medical Products Agency. Legemiddelsøk [Drug search]. [cited 2024 October 15]. Available from: https:// www.legemiddelsok.no/
The Skåne Health Care Region. Rekvisition för peruk och tatuering [Requisition for wig and tattoo]. [cited 2024 November 2]. Available from: https://vardgivare.skane.se/vardriktlinjer/hjalpmedel/anvisningar-sortiment/medicinskbehandling/anvisningar/?highlight=Hj%c3%a4lpmedel+peruk
Arbeids- og velferdsforvaltninga (NAV). Hjelpemiddel og Pengestøtte: Parykk. [cited 2024 October 26]. Available from: https://www.nav.no/parykk#hva
Folkehelseinstituttet. Statistikk og rapporter fra Kommunalt pasient- og brukerregister (KPR) [Statistics and reports from the Municipal Patient and User Register (KPR)]. [cited 2024 November 2]. Available from: https://www.fhi.no/he/kpr/statistikk-og-rapporter/
Sweden S. Average base and monthly salary as well as women’s salary as a percentage of men’s salary by sector, occupation (SSYK 2012), sex, and age. Years 2014–2022. [cited 2024 November 5]. Available from: https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__AM__AM0110__AM0110A/LonYrkeAlder4A/
Statistics Norway. Monthly earnings, by sector, age, industry, sex and working hours 2015 - 2024. [cited 2024 November 5]. Available from: https://www.ssb.no/en/statbank/table/11421/
Ekonomifakta. Sociala avgifter över tid 2024 [Social security contributions over time 2024]. [cited 2024 November 25]. Available from: https://www.ekonomifakta.se/sakomraden/skatt/skatt-pa-arbete/sociala-avgifter-overtid_1209267.html
Kinge JM, de Linde A, Dieleman JL, Vollset SE, Knudsen AK, Aas E. Production losses from morbidity and mortality by disease, age and sex in Norway. Scand J Public Health 2024; 52: 779–783. DOI: https://doi.org/10.1177/14034948231188237
Drummond SM, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. 3 edn. Oxford University Press; 2005. DOI: https://doi.org/10.1093/oso/9780198529446.001.0001
European Central Bank Eurosystem. Euro foreign exchange reference rates. [cited 2025 April 15]. Available from: https://www.ecb.europa.eu/stats/policy_and_exchange_rates/euro_reference_exchange_rates/html/eurofxref-graph-sek.en.html
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