Economic burden of immune-mediated and psychiatric comorbidities in patients with newly diagnosed vitiligo.

Abstract

Vitiligo is a chronic autoimmune skin disorder characterized by loss of melanocytes, resulting in patches of skin depigmentation across the body. Vitiligo can have a substantial negative impact on patients' health-related quality of life, is associated with increased health care costs, and has no known cure. To evaluate the prevalence and economic burden of immune-mediated and psychiatric comorbidities in patients with newly diagnosed vitiligo. This retrospective cohort study used data from the Merative MarketScan Commercial Database. Eligible patients were aged 12 to 64 years with a new diagnosis of vitiligo (<i>International Classification of Diseases, Tenth Revision</i>; codes L80.x, H02.73-, or N90.89); index date recorded on a nondiagnostic medical claim between January 1, 2019, and September 30, 2024, together with 12 months of pre-index continuous medical/pharmacy enrollment. Outcomes included prevalence of immune-mediated or psychiatric comorbidities at diagnosis (evaluated using up to 3 years of pre-index data) and associated per-patient per-month (PPPM) all-cause and vitiligo-related mean health care costs and health care resource utilization, both unadjusted and adjusted for age, sex, US region, and Charlson Comorbidity Index score. Comorbidities were summarized descriptively; health care costs were compared using γ log-link models. Among the 14,059 patients with vitiligo, 52.8% (n = 7,430) were female and the mean (SD) age was 43 (15) years. Overall, 23.8% of patients had at least 1 immune-mediated comorbidity, most commonly atopic dermatitis (8.0%), psoriasis (5.4%), Hashimoto thyroiditis (3.8%), and alopecia areata (2.0%). At least 1 psychiatric diagnosis was present in 39.4% of patients, most commonly anxiety (20.9%), sleep disturbance (15.2%), and depression (12.7%). PPPM all-cause mean total health care costs among patients with vitiligo and at least 1 immune-mediated comorbidity were significantly higher than those among patients without an immune-mediated comorbidity ($2,112 vs $957, respectively; <i>P</i> < 0.001), as were costs for those with vs without at least 1 psychiatric comorbidity ($1,751 vs $896, respectively; <i>P</i> < 0.001). Among patients with at least 1 Janus kinase-related comorbidity, PPPM costs were $2,105, compared with $1,041 for those without such comorbidities at baseline. This study highlights the substantial economic burden that patients with preexisting immune-mediated and psychiatric conditions face following vitiligo diagnosis. Approximately 1 in 4 patients had a prior diagnosis of at least 1 immune-mediated condition, reflecting the immunological pathogenesis of vitiligo and that it is not a cosmetic disease. Patients with immune-mediated and psychiatric comorbidities incurred significantly higher health care costs relative to those without these comorbidities, underscoring the need for a comprehensive, multidisciplinary approach to vitiligo management.