Resource utilization, work productivity and costs in patients with hidradenitis suppurativa: a cost-of-illness study

ABSTRACT

Background

Hidradenitis suppurativa (HS) is a, chronic skin disease affecting up to 1% of the population in Europe. This study aims to assess the cost-of-illness of HS from a societal perspective in Hungary and to analyze the predictors of costs.

Methods

A multicentre, cross-sectional cost-of-illness study was performed among 200 adult HS patients. We evaluated direct medical (physician consultations, inpatient admissions, medical, and surgeries), direct non-medical (transportation and caregiving), and indirect costs (productivity loss).

Results

The mean annual cost-of-illness of HS was €6,791 per patient. The main cost components were productivity loss (53.3%), biological treatment (21.5%), and informal care (9.2%). Patients missed, on average, 26 and 63 days from work annually due to absenteeism and presenteeism, respectively. Male sex, more severe disease, gluteal involvement, and coexisting inflammatory bowel disease were associated with higher direct medical costs, while lower education level and worse quality-of-life outcomes predicted higher indirect costs.

Conclusion

This is the first study to assess both direct and indirect costs in HS patients. HS imposes a substantial burden on patients and society, predominantly arising from productivity loss and biological therapy. Resource utilization data and cost-of-illness estimates provide valuable inputs into cost-effectiveness analyses of health interventions in HS.

KEYWORDS:

• Cost-of-illness
• productivity loss
• absenteeism
• presenteeism
• informal care
• hidradenitis suppurativa

Acknowledgement

The Dept. of Dermatology, University of Debrecen, Debrecen, Hungary is a health care unit of the European Reference Network for Rare and Complex Skin Diseases (ERN Skin).

Article highlights

• This is the first cost-of-illness study among HS patients that report both direct and indirect costs.

• In 2019, the average annual total cost-of-illness of HS was €6,791 per patient in Hungary, the lowest in patients who received systemic non-biological therapy (€3,595) and the highest in patients treated surgically (€7,282) or with biological treatment (€16,005).

• HS is associated with a substantial economic burden mainly driven by presenteeism (26.2%), absenteeism (23.5%), biological therapy (21.5%) and informal care (9.2%).

• Male sex, more severe disease, gluteal involvement and coexisting inflammatory bowel disease are associated with higher direct medical costs, while lower education level and worse quality-of-life outcomes predict higher indirect costs.

Declaration of interest

In connection to this article, B.J. and F.R. have received grant support from the Higher Education Institutional Excellence Program 2020 of the Ministry of Human Capacities in the framework of the ‘Financial and Public Services’ research project (TKP2020-IKA-02) at the Corvinus University of Budapest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Authors’ contribution

All authors contributed to the study conception and critical review of the paper. K.G. H.L.G., N.W., A.S., E.R., V.B. and F.R. developed the study design and interpreted the data. Data collection was performed by H.L.G., K.G., Á.K., N.K and A.B. Data analysis was performed by B.J., X.J., Z.B., V.B. and F.R. Funding was obtained by A.S. and V.B. The manuscript was drafted by K.G. and F.R. All authors read and approved the final manuscript.

Availability of data and material

All data of this study are available from the corresponding author upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

The publication was supported by Hungarian Research Grants (NKFIH K128250) and GINOP-2.3.2-15-2016-00050 and EFOP-3.6.1-16- 2016-00022 projects (KG and AS). The project was co-financed by the European Union, the European Regional Development Fund, and the European Social Fund (KG and AS). This research was supported by the Higher Education Institutional Excellence Program 2020 of the Ministry for Innovation and Technology in Hungary in the framework of the ‘Financial and Public Services’ research project (TKP2020-IKA-02) at the Corvinus University of Budapest.