Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims

Abstract

Introduction: Alopecia areata (AA) is an autoimmune disorder causing sudden, nonscarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA. Methods: Patients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan Ò Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis.Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data. Results: A total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs. Conclusion: Patients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population.

Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States

“…However, the claims data study reported an apparent much higher rate of topical corticosteroids use (80.3% vs our 11% topical corticosteroids/TCI and 45% combination corticosteroids use) and a lower immunomodulators use (3.6% vs 10%). Further, Senna et al also did not report use of injectable corticosteroids [6]. Differences may be in part due to different AA severity distributions (not reported for the claims database study) and the difference in study period.…”

“…2 Current treatment groups by severity of AA at therapy initiation. Missing n = 15 patients due to ' 'severity at Initiation' ' missing or unknown less than 2% with other treatments (e.g., phototherapy) [6]. A direct parison with this claims database study was not feasible as reported treatments were not mutually exclusive as we defined mutually exclusive treatment groups considering combination therapy groups.…”

“…For instance, a recent international Delphi panel on treatment reached consensus for only a third of treatmentspecific questions [5]. Two recently published USA-based national studies contain limited treatment information, without reporting on treatment switches, treatment by AA severity, or treatment satisfaction [6,7]. The most common AA treatments reported for US data were topical and injectable corticosteroids [7].…”

Health‐related quality of life in patients with alopecia areata: Results of a Japanese survey with norm‐based comparisons

“…Social stigmatization or even its perception in patients may result in shy, cautious, aggressive, retreating, evasive, or defensive behavior 4 . Lack of awareness of AA is another unmet need prevailing among individuals experiencing hair loss and they often misconstrue hair loss as just cosmetic and are negligent about it; however, this chronic disorder can lead to diverse comorbidities which may further influence HRQoL 10 . Multiple comorbid conditions associated with AA include atopic, metabolic, rheumatoid, thyroid, and psychiatric diseases 11 .…”

“…4 Lack of awareness of AA is another unmet need prevailing among individuals experiencing hair loss and they often misconstrue hair loss as just cosmetic and are negligent about it; however, this chronic disorder can lead to diverse comorbidities which may further influence HRQoL. 10 Multiple comorbid conditions associated with AA include atopic, metabolic, rheumatoid, thyroid, and psychiatric diseases. 11 Numerous studies have reported a greater risk of psychiatric disorders in patients with AA.…”