OBJECTIVES

Generalized pustular psoriasis (GPP) is a rare, life-threatening autoinflammatory disease whose indirect burden of illness (BOI) is unknown. This study examines work loss and indirect costs associated with GPP.

METHODS

A retrospective cohort study (01JAN2015-31MAR2017) in OptumHealth Care Solutions private-payer employer database, included individuals aged 18-64 with ≥1 diagnosis of GPP (ICD-10-CM code: L40.1) and ≥3 months of continuous medical and pharmacy enrollment pre- and post- index follow-up. GPP patients were matched (1:5) to non-GPP controls and a plaque psoriasis (PsO) cohort based on age, sex, region, insurance type, and index year. Indirect BOI defined as leave of absence (LOA) and medically-related absenteeism, and monthly costs (inflated to 2019 USD) were measured. Adjusted and unadjusted models compared indirect BOI between GPP and matched cohorts.

RESULTS

Out of 327 GPP patients, 66 met inclusion criteria. GPP patients were often male (55%) with a mean age of 47 years. Compared to non-GPP controls, GPP was associated with more days-per-month of medically-related absenteeism (rate ratio (RR) [95% confidence interval (CI)]: 2.1 [1.7, 2.6]), higher odds of medically-related absenteeism (odds ratio (OR) [95% CI]: 40.8 [5.5, 301.4]), higher odds of LOA (OR [95% CI]: 8.5 [1.04, 69.2]), and higher absenteeism costs (mean difference (MD): $83, p=0.001). GPP days-per-month of medically-related absenteeism (RR [95% CI]: 1.1 [0.9, 1.4]), LOA (OR [95% CI]: 2.9 [0.5, 17.5]), and absenteeism costs (MD: -$21, p=0.503) were comparable to the PsO cohort.

CONCLUSIONS

Finding that the indirect BOI of GPP is comparable to PsO with well-established high BOI underscores the need for therapies to reduce LOA and medically-related absenteeism. Limited to a working population, the study did not account for BOI due to early retirement and long-term disability. Future research should examine more severe GPP populations to quantify disability and early retirement for a more comprehensive understanding of the indirect BOI of GPP.