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

BACKGROUND: 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. OBJECTIVE: To evaluate the prevalence and economic burden of immune-mediated and psychiatric comorbidities in patients with newly diagnosed vitiligo. METHODS: 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 (International Classification of Diseases, Tenth Revision; 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. RESULTS: 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; P < 0.001), as were costs for those with vs without at least 1 psychiatric comorbidity ($1,751 vs $896, respectively; P < 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. CONCLUSIONS: 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.