Vitiligo: Epidemiology and Economic Impact
Keywords:
vitiligo, epidemiology, mental health, social costAbstract
Introduction: Vitiligo is an acquired disorder of pigmentation, characterized by the development of white patches on the skin, often with a typical symmetrical distribution and progressive extension [1,2]. Although vitiligo does not cause direct physical impairment, it can produce a relevant psychosocial burden. Despite this burden, effective treatments are lacking, emphasizing the need for new therapeutic options.
Objectives: The aim of this study was to systematically scan the scientific literature for studies dealing with vitiligo epidemiology. Additionally, the study aimed to assess the social costs of vitiligo, ultimately raising awareness about the societal impact of the condition. The focus was on Italian data.
Methods: Our research employed a comprehensive methodology. For the epidemiology, we systematically searched PubMed database up to October 2023 and complemented the analysis with Real World Evidence. For social costs, we conducted an in-depth literature review, administered a web-survey to 20 Italian dermatologists and conducted an equivalent number of interviews during the same period in March 2022.
Results: The data suggest that in Italy the prevalence of vitiligo increases with age, and it varies from 0.19% (age 18-21) to 0.6% (age >45) [3,4]. We estimated 152,000 patients diagnosed with Non-Segmental Vitiligo (NSV) in Italy; based on Body Surface Area (BSA), 33% are Not Severe, 31% Mild, 27% Moderate/Severe, 9% Very Severe. The yearly social costs of vitiligo amount to €0.5Bln.
Conclusions: There is a remarkable association of vitiligo with anxiety and depression [5,6,7,8,9], and Mental Health is associated with 30% of social costs. Moreover, vitiligo social costs distribution highlights inequity, with patients bearing 55% of them.
References
Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015; 386:74-84.
Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol. 2021; 48:252-270.
Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. The 'EpiEnlist' project: a dermo-epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions. J Eur Acad Dermatol Venereol. 2007 Sep;21(8):1091-6.
Naldi L, Parazzini F, Gallus S; GISED Study Centres. Prevalence of atopic dermatitis in Italian schoolchildren: factors affecting its variation. Acta Derm Venereol. 2009; 89:122-5.
Lai YC, Yew YW, Kennedy C, Schwartz RA. Vitiligo and depression: a systematic review and meta-analysis of observational studies. Br J Dermatol. 2017; 177:708-718.
Wang G, Qiu D, Yang H, Liu W. The prevalence and odds of depression in patients with vitiligo: a meta-analysis. J Eur Acad Dermatol Venereol. 2018; 32:1343-1351.
Kussainova A, Kassym L, Akhmetova A, Glushkova N, Sabirov U, Adilgozhina S, et al. Vitiligo and anxiety: A systematic review and meta-analysis. 2020; PLoS ONE 15(11): e0241445.
Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol. 2021; 22:757-774.
Picardo M, Huggins RH, Jones H, Marino R, Ogunsola M, Seneschal J. The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol. 2022; 36:1507-1523.
Rodrigues M. Skin cancer risk (nonmelanoma skin cancers/melanoma) in vitiligo patients. Dermatologic clinics, 2017, 35.2: 129-134.Silverberg N.B. et al. 2010
Gawkrodger DJ, Ormerod AD, Shaw L, Mauri‐Sole I, Whitton ME, Watts MJ, Young K. Guideline for the diagnosis and management of vitiligo. British Journal of Dermatology. 2008; 159(5), 1051-1076.
Bergqvist C, and Ezzedine K Vitiligo: a review. Dermatology 236.6. 2020; 571-592.
A Taieb, A Alomar, M Böhm, M L Dell'anna, A De Pase, V Eleftheriadou, K Ezzedine, Y Gauthier, D J Gawkrodger, T Jouary, G Leone, S Moretti, L Nieuweboer-Krobotova, M J Olsson, D Parsad, T Passeron, A Tanew, W van der Veen, N van Geel, M Whitton, A Wolkerstorfer, M Picardo Guidelines for the management of vitiligo: the European Dermatology Forum consensus, Br J Dermatol 2013 Jan;168(1):5-19
Krüger C, and Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. International journal of dermatology 51.10. 2012; 1206-1212.
Ezzedine K, Seneschal J, Da Silva A, Préaubert N, Lamblin A, Delattre C, Emery C, Nevoret C, Finzi J, Bouée S, Passeron T. Vitiligo patient population and disease burden in France: VIOLIN study results from the CONSTANCES cohort. J Eur Acad Dermatol Venereol. 2023 Aug 21; Epub ahead of print
Picardo M, Dell'Anna ML, Ezzedine K., Hamzavi I., Harris JE, Parsad D, Taieb A Vitiligo Nature Reviews Disease Primers, 15011 (2015)
Hadi A, Wang JF, Uppal P, Penn LA, Elbuluk N. Comorbid diseases of vitiligo: a 10-year cross-sectional retrospective study of an urban US population. Journal of the American Academy of Dermatology. 2020; 82(3), 628-633.
Teasdale E, Muller I, Sani AA, Thomas KS, Stuart B, Santer M. Views and experiences of seeking information and help for vitiligo: a qualitative study of written accounts. BMJ open. 2018; 8(1), e018652.
Radtke MA, Schäfer I, Gajur A, Langenbruch A, & Augustin M. Willingness‐to‐pay and quality of life in patients with vitiligo. British Journal of Dermatology. 2009; 161(1), 134-139.
Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo F, Sturm D, Pandya A EADV 2020. Poster P1239 (Paris, France) Prevalence of Psychosocial Comorbidities in Vitiligo: A Systematic Literature Review
Firooz A, Bouzari N, Fallah N, Ghazisaidi B, Firoozabadi MR, Dowlati Y. What patients with vitiligo believe about their condition. International journal of dermatology. 2004; 43(11), 811-814.
Zhang Y, Cai Y, Shi M, Jiang S, Cui S, Wu Y, et al. The Prevalence of Vitiligo: A Meta- Analysis. 2016; PLoS ONE 11(9): e0163806. doi:10.1371/ journal.pone.0163806.
Osinubi O, Grainge MJ, Hong L, Ahmed A, Batchelor JM, Grindlay D, Thompson AR, Ratib S. The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis. Br J Dermatol. 2018; 178:863-878.
Liu CW, Huang YC. Vitiligo and autoantibodies: a systematic review and meta-analysis. J Dtsch Dermatol Ges. 2018; 16:845-851.
Saikarthik P, Reddy VH, Rafi SM, Basha VW, Padmakar S. A Systematic Review on Prevalence and Assessment of Sexual Dysfunction in Vitiligo. J Assoc Physicians India. 2022; 70:11-12.
Xia J, Melian C, Guo W, Usmani H, Clark R, Lozeau D. Vitiligo and Metabolic Syndrome: Systematic Review and Meta-Analysis. JMIR Dermatol. 2022 Mar 16; 5(1):e34772.
Kang P, Zhang WG, Ji ZH, Shao ZJ, Li CY. Association between vitiligo and relevant components of metabolic syndrome: a systematic review and meta-analysis. J Dtsch Dermatol Ges. 2022; 20:629-641.
Rooker A, Ouwerkerk W, Bekkenk MW, Luiten RM, Bakker WJ. The Risk of Keratinocyte Cancer in Vitiligo and the Potential Mechanisms Involved. J Invest Dermatol. 2023 Oct 2; S0022-202X(23)02566-6.
Naldi L, Colombo P, Placchesi EB, et al. Study design and preliminary results from the pilot phase of the PraKtis study: self-reported diagnoses of selected skin diseases in a representative sample of the Italian population. Dermatology. 2004; 208:38-42.
Sampogna F, Raskovic D, Guerra L, Pedicelli C, Tabolli S, Leoni L, Alessandroni L, Abeni D. Identification of categories at risk for high quality of life impairment in patients with vitiligo. Br J Dermatol. 2008; 159:351-9.
Naldi L, Parazzini F, Gallus S; GISED Study Centres. Prevalence of atopic dermatitis in Italian schoolchildren: factors affecting its variation. Acta Derm Venereol. 2009; 89:122-5.
Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. Vitiligo and autoimmunity: an epidemiological study in a representative sample of young Italian males. J Eur Acad Dermatol Venereol. 2011; 25:105-9.
Ingordo V, Cazzaniga S, Gentile C, Iannazzone SS, Cusano F, Naldi L. Dermatology Life Quality Index score in vitiligo patients: a pilot study among young Italian males. G Ital Dermatol Venereol. 2012; 147:83-90.
Ingordo V, Cazzaniga S, Medri M, Raone B, Digiuseppe MD, Musumeci ML, Romano I, Fai D, Pellegrino M, Pezzarossa E, Di Lernia V, Peccerillo F, Battarra VC, Sirna R, Patrizi A, Naldi L. To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index. Dermatology. 2014; 229:240-7
Svensson A, Ofenloch RF, Bruze M, Naldi L, Cazzaniga S, Elsner P, Goncalo M, Schuttelaar MA, Diepgen TL. Prevalence of skin disease in a population-based sample of adults from five European countries. Br J Dermatol. 2018; 178:1111-1118.
Martini N., et al. Real World Evidence (RWE) analysis of vitiligo patients. 2022
Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. Journal of the American Academy of Dermatology. 1996; 35(5), 671-674.
Silverberg JI, Silverberg AI, Malka E, Silverberg NB. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. Journal of the American Academy of Dermatology. 2010; 62(6), 937-941.
Lin Z, Tian Y, Bai B, Liu M, Wu Y, Xiao B, Chen HD. Comprehensive survey of vitiligo patients in the northeast of China using a predesigned questionnaire. The Journal of Dermatology. 2018; 45(1), 39-45.
Lotti T, et al. Linee guida e raccomandazioni SIDeMaST: Vitiligine. 2022.
Van Geel N, Uitentuis SE, Zuidgeest M, Wolkerstorfer A, Bekkenk MW, Moock C, Speeckaert R. Validation of a Patient Global Assessment for extent, severity and impact to define the severity strata for the Self Assessment Vitiligo Extent Score (SA‐VES). Journal of the European Academy of Dermatology and Venereology. 2021; 35(1), 216-221.
Sobocki P, Pugliatti M, Lauer K, Kobelt G Estimation of the cost of MS in Europe: extrapolations from a multinational cost study. 2007
Doria A, Amoura Z, Cervera R, Khamastha MA, Schneider M, Richter J, Boucot I. Annual direct medical cost of active systemic lupus erythematosus in five European countries. Annals of the rheumatic diseases. 2014; 73(1), 154-160.
Jönsen A. et al. Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts. 2015
Møllehave LT, Linneberg A, Skaaby T, Knudsen N, Ehlers L, Jorgensen T, Thuesen BH. Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015. European Thyroid Journal. 2018; 7(2), 75-83.
Vadziuk I, Klishch I, Markiv I. 12-month cost of illness analysis of the thyroid disease in Ukraine. PubMed 2013
Benucci M, Rogai V, Atzeni F, Hammen V, Sarzti-Puttini P, Migliore A. Costs associated with rheumatoid arthritis in Italy: past, present, and future. ClinicoEconomics and Outcomes Research. 2016; 33-41.
Landfeldt E, Pogoryelova O, Sejersen T, Zethraeus N, Breiner A, Lochmüller H. Economic costs of myasthenia gravis: a systematic review. Pharmacoeconomics. 2020; 38, 715-728.
Schepelmann K, Winter Y, Spottke AE, Claus D, Grothe C, Schröder R, Dodel R. Socioeconomic burden of amyotrophic lateral sclerosis, myasthenia gravis and facioscapulohumeral muscular dystrophy. Journal of neurology. 2010; 257, 15-23.
Vidal-Alaball J, Butler CC, Potter CC. Comparing costs of intramuscular and oral vitamin B12 administration in primary care: a cost-minimization analysis. Eur J Gen Pract. 2006; 12(4):169-73.
Khellaf M, Le Moine JG, Poitrinal P, Francesconi C, Haddad A, Bierling P, Michel M, Eckert L, Launois R, Godeau B. Costs of managing severe immune thrombocytopenia in adults: a retrospective analysis. Ann Hematol. 2011 Apr; 90(4):441-6. PMID: 20922528.
Mounié M, Costa N, Conte C, Petiot D, Fabre D, Despas F, Lapeyre-Mestre M, Laurent G, Savy N, Molinier L. Real-world costs of illness of Hodgkin and the main B-Cell Non-Hodgkin lymphomas in France. J Med Econ. 2020 Mar; 23(3):235-242. Epub 2019 Dec 26. PMID: 31876205.
Principi M, Labarile N, Bianchi FP, Contaldo A, Tafuri S, Ierardi E, Di Leo A. The Cost of Inflammatory Bowel Disease Management Matches with Clinical Course: A Single Outpatient Centre Analysis. Int J Environ Res Public Health. 2020 Jun 24; PMCID: PMC7344991.
De Girolamo G, Polidori G, Morosini P, Scarpino V, Reda V, Serra G, Mazzi F, Alonso J, Vilagut G, Visonà G, Falsirollo F, Rossi A, Warner R. Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Soc Psychiatry Psychiatr Epidemiol. 2006 Nov; Epub 2006 Aug 16. PMID: 16915360.
Perrone V, Sangiorgi D, Andretta M, Ducci G, Forti B, Francesa Morel PC, Gambera M, Maina G, Mencacci C, Mennini FS, Zanalda E, Degli Esposti L. Healthcare Resource Consumption and Related Costs of Patients Estimated with Treatment-Resistant Depression in Italy. Clinicoecon Outcomes Res. 2021 Jul 5; PMCID: PMC8275098.
Ruggeri M, Drago C, Mandolini D, Francesa Morel P, Mencacci C, Starace F. The costs of treatment resistant depression: evidence from a survey among Italian patients. Expert Review of Pharmacoeconomics & Outcomes Research. 2022; 437-444.
Pugliatti M, Sobocki P, Beghi E, Pini S, Cassano GB, Altamura AC, Pozzoli S, Rosati G; Cost of Disorders of the Brain in Europe" Study Group. Cost of disorders of the brain in Italy. Neurol Sci. 2008 Apr; Epub 2008 May 16; PMID: 18483707.
Adnkronos Sanità, 2019
Kirch, W Encyclopedia of Public Health: Volume 1: A-H Volume 2: I-Z. Springer Science & Business Media. 2008
Garattini L, Ghislandi S, Tediosi F. L'inclusione dei costi indiretti nelle valutazioni economiche: la situazione italiana. CESAV. 2000.
Nuova Assicurazione Sociale per l'Impiego (NASpI), ISTAT website
Verbooy K, Hoefman R, van Exel J, Brouwer W. Time Is Money: Investigating the Value of Leisure Time and Unpaid Work. Value Health. 2018 Dec; Epub 2018 Jul 14. PMID: 30502787.
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