Beyond quality of life: A call for patients' own willingness to pay in chronic skin disease to assess psychosocial burden—A multicenter, cross-sectional, prospective survey

Bae, Jung Min; Kim, Jung Eun; Lee, Ro Woo; Ju, Hyun Jeong; Han, Ju Hee; Lee, Joo Hee; Woo, Yu Ri; Lee, Ji Hae; Bang, Chul Hwan; Park, Chul Jong; Ezzedine, Khaled; Kim, Miri

doi:10.1016/j.jaad.2020.09.088

Cited by 14 publications

(19 citation statements)

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“…The QoL and/or psychosocial burden of vitiligo was most frequently compared with psoriasis (26 articles) [ 4 , 9 , 27 , 58 , 60 , 76 , 83 , 84 , 87 , 92 , 110 , 111 , 113 , 118 , 123 , 130 , 134 , 136 , 137 , 150 , 154 , 159 , 162 , 173 , 174 ], alopecia areata (13 articles) [ 14 , 24 , 58 , 60 , 75 , 76 , 83 , 109 , 118 , 154 , 159 , 173 , 174 ], acne (11 articles) [ 14 , 58 , 76 , 117 , 118 , 137 , 140 , 154 , 159 , 174 , 175 ], atopic dermatitis (ten articles) [ 27 , 58 , 73 , 76 , 110 , 111 , 119 , 154 , 173 , 174 ], and urticaria (nine articles) [ 27 , 58 , 76 , 137 , 154 , 155 ,…”

Section: Resultsmentioning

confidence: 99%

“…In addition, the heterogeneity of studies included in this review may further complicate direct comparisons of general QoL in vitiligo with other dermatologic diseases. Interestingly, a recent study in South Korea showed that willingness to pay was highest in vitiligo compared with other dermatologic diseases including atopic dermatitis and psoriasis, despite lower median DLQI scores in patients with vitiligo [ 27 ]. The application of widely used generic QoL instruments in vitiligo may therefore be better suited for comparison across demographic or clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Five studies reported that depression [30,84,85,102,164] and/or anxiety [84,164] scores measured by Beck Inventory scales were not significantly different in patients with vitiligo vs controls. The QoL and/or psychosocial burden of vitiligo was most frequently compared with psoriasis (26 articles) [4,9,27,58,60,76,83,84,87,92,110,111,113,118,123,130,134,136,137,150,154,159,162,173,174], alopecia areata (13 articles) [14,24,58,60,75,76,83,109,118,154,159,173,174], acne (11 articles) [14,58,76,…”

Section: Degree Of Psychosocial Burdenmentioning

confidence: 99%

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Psychosocial Effects of Vitiligo: A Systematic Literature Review

et al. 2021

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Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1-62.3%) and anxiety (20 studies, 1.9-67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3-100%), adjustment disorders (12 studies, 4-93.9%), sleep disturbance (seven studies, 4.6-89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0-81.8%), and avoidance or restriction behavior (12.5-76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligoassociated burden of disease. Protocol Registration PROSPERO (CRD42020162223).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Degree Of Psychosocial Burdenmentioning

confidence: 99%

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Psychosocial Effects of Vitiligo: A Systematic Literature Review

et al. 2021

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“…Vitiligo is clinically characterized by white patches resulting from the selective loss of melanocytes and affects 0.1%–2% of the population worldwide 1–4 . While vitiligo does not affect life expectancy, it is important not to dismiss it as a cosmetic condition as it can be psychologically devastating, with a considerable burden on daily life and with patients often enduring stigmatization and social isolation 5–9 . In 2011, an international consensus has revised the classification of vitiligo 10 .…”

Section: Introductionmentioning

confidence: 99%

Vitiligo: A focus on pathogenesis and its therapeutic implications

Bergqvist

Ezzedine

2021

The Journal of Dermatology

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Vitiligo is the most common depigmenting disorder affecting 0.1%–2% of the population worldwide. The characteristic white patches result from the selective loss of melanocytes. Sustained recent efforts have resulted in a detailed understanding of the genetic architecture of vitiligo. About 80% of vitiligo risk is attributable to genetic factors; and the rest (20%) is attributable to the environment. Over the past decade, substantial progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Melanocytes from patients with vitiligo are more susceptible to oxidative stress which begets the release of exosomes and inflammatory cytokines that will lead to activation of the innate immune response and subsequently to adaptive immune response through activation of autoreactive cytotoxic CD8+ T cells. These produce interferon‐γ (IFN‐γ) which promotes disease progression through IFN‐γ‐induced chemokine secretion from surrounding keratinocytes to further recruit T cells to the skin through a positive feedback loop. CD8 tissue‐resident memory T cells are in turn responsible for long‐term maintenance and potential relapse of vitiligo in human patients through cytokine‐mediated recruitment of T cells from the circulation. This review summarizes the current knowledge on vitiligo and attempt to give an overview of the future in vitiligo treatment.

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“…Patients with vitiligo report emotional problems on the Skindex‐29 comparable to those of patients with psoriasis, eczema, chronic hand dermatitis, and acne 20 . Furthermore, when considering patients’ willingness to pay to cure or improve their condition, the impact of vitiligo on patient quality of life is higher in magnitude than that of eczema and psoriasis 30 . Therefore, it could reasonably be argued that the treatment of vitiligo should be fully covered as is the case with eczema and psoriasis treatments.…”

Section: Discussionmentioning

confidence: 99%

The scope of health insurance coverage of vitiligo treatments in the United States: Implications for health care outcomes and disparities in children of color

Blundell

Sachar

Gabel

et al. 2021

Pediatric Dermatology

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Background Patients of color are disproportionately impacted by vitiligo. Access to treatment depends greatly on insurance coverage. We, therefore, assessed current vitiligo treatment coverage policies across major United States health insurers to determine current patterns and coverage gaps for vitiligo. Methods The study surveyed 15 commercial health care insurers, 50 BlueCross BlueShield (BCBS) plans, Medicare, Medicaid, and Veterans Affairs. Information on treatment coverage for vitiligo, specifically pimecrolimus and tacrolimus, excimer laser therapy, PUVA, and narrow‐band (nb)UVB, was collected via an online review of insurance policy documents, confirmed with phone calls to organization representatives, or via a survey of Medicaid providers, and state Medicaid directors. Results Of 17 organizations with regional or national coverage policies, 12% did not cover topical calcineurin inhibitors, 56% did not cover nbUVB phototherapy, 53% did not cover PUVA phototherapy, and 41% did not cover laser therapy. For BCBS, pimecrolimus and tacrolimus were not covered in 39% and 35% of states, respectively. NbUVB and PUVA therapy were not covered in 20% and 10% of states, respectively. Excimer laser therapy was not covered in 82% of states. Out of 32 states with accessible Medicaid information, 11 did not cover topicals, 5 did not cover nbUVB, 4 did not cover PUVA, and 7 did not cover laser. Two commonly cited reasons for coverage denial were that the treatment indication was considered cosmetic, and certain therapies are not FDA‐approved. Conclusions There is inequity in the distribution of health among vitiligo patients given current patterns of insurance coverage for treatment, which may have disproportionate impact on patients of color.

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Beyond quality of life: A call for patients' own willingness to pay in chronic skin disease to assess psychosocial burden—A multicenter, cross-sectional, prospective survey

Cited by 14 publications

References 6 publications

Psychosocial Effects of Vitiligo: A Systematic Literature Review

Psychosocial Effects of Vitiligo: A Systematic Literature Review

Vitiligo: A focus on pathogenesis and its therapeutic implications

The scope of health insurance coverage of vitiligo treatments in the United States: Implications for health care outcomes and disparities in children of color

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