Alopecia Areata Associated With High Cost Burden for Health Plans, Adolescents

Adolescent patients with prevalent alopecia areata (AA) experienced greater health care resource utilization and higher costs compared to non-AA controls, according to findings published in the Journal of Health Economics and Outcomes Research.

AA affects an estimated 0.21% of Americans, and 20% of patients with AA in the United States are aged 16 years or younger. Patients often have comorbid autoimmune and inflammatory conditions such as atopic dermatitis, lupus erythematosus, and psoriasis, among others, which contribute to the burden of AA, researchers said.

“Patients with AA can present with small patches of hair loss; complete loss of scalp hair, known as alopecia totalis (AT); or complete loss of scalp, facial, and body hair, known as alopecia universalis (AU),” investigators said. “Prior research suggests that the clinical burden of AA may translate into a considerable economic burden for payers and patients.”

To study this burden, researchers conducted a large-sample, real-world analysis using the IBM MarketScan Commercial and Medicare databases. Patients aged 12 to 17 years were included if they had at least 2 claims documenting their diagnosis from October 2015 through March 2018. Index year, demographics, health plan type, and Charlson Comorbidity Index were used to match patients 1:3 with non-AA controls.

Of 1235 total patients with AA, 130 patients had AT/AU. Compared to controls, patients with AT/AU had more outpatient visits (14.5 vs 7.1) as well as dermatologist visits (3.6 vs 0.3) per patient per year.

Additionally, average health plan costs were higher, at $9397 for patients with AT/AU vs $2267 for non-AA controls. Excess costs included higher medical ($7480 vs $1780), pharmacy ($1918 vs $487), and out-of-pocket costs ($2081 vs $751) (all P < .001), researchers said.

There were 1105 patients with non-AT/AU AA. Like those with AT/AU, these patients had more outpatient (11.6 vs 8.0) and dermatologist visits (3.4 vs 0.4) compared to controls.

Costs were also greater for the non-AT/AU group compared to controls, but the economic burden was less substantial than that of the AT/AU group. Average health plan costs were $7578 for patients with non-AT/AU vs $4496 for controls, and out-of-pocket costs were also greater ($1579 vs $805) (all P < .001).

Patients with AT/AU “had substantially higher rates of oral corticosteroid use and lower rates of injectable corticosteroid use during the follow-up period” as compared to patients with non-AT/AU. Researchers said further research into real-world treatment patterns is needed.

Overall, adolescent patients with AA experienced significant incremental health care costs and excess utilization, resulting in a high burden for health plans.

“This study provides real-world evidence in the commercially insured US population that AA is associated with a significant economic burden among one of the most vulnerable patient populations—adolescents—who are at a critical period of developing their self-identity,” investigators said.

Reference:
Ray M, Swallow E, Gandhi K, et al. Healthcare utilization and costs among US adolescents with alopecia areata. J Health Econ Outcomes Res. 2022;9(2):11-18. doi:10.36469/001c.36229