OBJECTIVES

Palmoplantar Pustulosis (PPP) is a chronic, debilitating, painful inflammatory disease affecting the palms and soles. The indirect burden of illness (BOI) of PPP is unknown. This study examines work loss and indirect costs associated with PPP.

METHODS

A retrospective cohort study (01JAN2015-31MAR2017) in OptumHealth Care Solutions private-payer employer database, included individuals aged 18-64 with ≥1 diagnosis of PPP (ICD-10-CM code: L40.3) and ≥3 months of continuous medical and pharmacy enrollment pre- and post- index follow-up. PPP patients were matched (1:5) to non-PPP 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 PPP and matched cohorts.

RESULTS

Out of 321 PPP patients, 83 met cohort inclusion criteria. PPP patients were often female (68%) with a mean age of 52 years. Compared to non-PPP controls, PPP was associated with more days-per-month of medically-related absenteeism (rate ratio (RR) [95% confidence interval (CI)]: 1.5 [1.2, 1.8]) mostly due to outpatient visits/other services (0.62 vs. 0.40, p=0.001) and higher absenteeism costs (mean difference (MD): $84, p=0.001). PPP days-per-month of medically-related absenteeism (RR [95% CI]: 0.9 [0.7, 1.1]) and absenteeism costs (MD: -$26, p=0.417) were comparable to the PsO cohort. LOA was not observed in the PPP cohort.

CONCLUSIONS

Finding that the indirect BOI of PPP is comparable to PsO with well-established high BOI underscores the need for therapies to reduce medically-related absenteeism and indirect costs. 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 PPP populations to quantify disability and early retirement for a more comprehensive understanding of the indirect BOI of PPP.