On the economic burden of alopecia areata in Romania

Abstract

Introduction Alopecia areata (AA) is an immune-mediated disorder that substantially impairs quality of life, social participation, and work productivity while generating considerable healthcare costs. Data regarding its economic burden in Romania are currently lacking. Methods We conducted a societal-perspective cost-of-illness study for the reference year 2022, combining a cross-sectional online survey of patients and caregivers (41 adult patients and 7 caregiver proxies, of whom 4 reported for pediatric patients) with four national secondary data sources: alopecia areata-specific epidemiological estimates from the Global Burden of Disease (GBD) 2021 study, pharmaceutical market data (IQVIA), hospitalization cost and discharge statistics, and national labor statistics. Survey-derived unit costs were extrapolated to the national level using both prevalence- and incidence-based approaches, combining bottom-up (treatment, medical services, associated expenses), top-down (hospitalizations), and hybrid (productivity losses) costing. Health-related quality of life was assessed with the EQ-5D-5L. Results The estimated total cost of alopecia areata in Romania in 2022 was EUR 97.95 million for adults and EUR 3.35 million for pediatric patients under the prevalence-based approach, and EUR 170.56 million and EUR 6.37 million, respectively, under the incidence-based approach. In adults, productivity losses (45.2–51.2%) and associated out-of-pocket expenses (28.5–32.2%) were the largest contributors, followed by medical services and treatment. Among pediatric patients, associated expenses, caregiver productivity losses, and treatment were the main cost drivers. Average annual cost per adult patient was EUR 2,608.6, and was higher for mild (EUR 3,248.3) than for severe disease (EUR 1,999.4). Problems with anxiety/depression were the most frequently affected EQ-5D-5L dimension (77.8% of adult respondents; 6 of 7 caregiver proxies). Discussion This is the first study to estimate the economic burden of alopecia areata in Romania. Although the survey sample was small and self-selected, the combination of patient-reported unit costs with national epidemiological and administrative data allowed national burden estimates under transparent assumptions. The findings highlight the substantial societal cost of alopecia areata — driven primarily by productivity losses and out-of-pocket spending rather than by reimbursed care — and support its consideration in healthcare resource allocation and service planning. Larger, representative studies are warranted to validate these estimates.