OBJECTIVES : Alopecia areata (AA) is an autoimmune hair-loss disease, with variations in clinical expression, including total scalp (alopecia totalis, AT) and total body hair-loss (alopecia universalis, AU). This study identified subgroups of patients with AA in the US with distinct profiles and their corresponding healthcare costs.

METHODS : IBM MarketScan Commercial & Medicare databases were analyzed. Patients aged 12+, with ≥2 claims with AA/AT/AU diagnosis (ICD-10 L63.*) from 10/1/2015 to 3/31/2018, and continuous enrollment (≥12 months) pre- and post-first AA/AT/AU diagnosis (index), were identified. Latent class analysis was used to differentiate subgroups with distinct demographic and clinical profiles. Baseline characteristics and post-index total all-cause per-patient-per-year (PPPY) plan costs, out-of-pocket (OOP) costs, and differential costs for subgroups vs. matched non-AA controls were compared.

RESULTS : The study included 16,207 AA patients (mean age 41.3 years, 64.5% female, 8.5% AT/AU). Eight subgroups, sized between 233 and 5,583 patients, were identified using the best-fitting model (lowest Bayesian Information Criterion). Mean±standard deviation (SD) all-cause PPPY costs varied across subgroups (range= $7,668±$40,935 to $29,042±$61,806). Differential total costs vs. controls ranged from $1,698±$1,847 to $12,367±$3,140. Mean±SD OOP costs ranged between $1,630±$2,294 to $3,572±$3,589. The two subgroups with the highest total PPPY costs ($28,621±$81,505 and $29,042±$61,806, respectively) were predominantly female (80-90%), had higher AT/AU (12-14%), and high rates (25-50%) of atopic, autoimmune, cardiovascular, and mental health comorbidities.

The two lowest total PPPY costs subgroups were composed of only 100% females ($9,339±$25,769) and 100% males ($7,668±$40,935), respectively, with lower comorbidity burden (≤15%). However, these subgroups also had higher differential total PPPY costs ($1,964±$409 and $2,954±$612, respectively) vs. controls (p<0.001).

CONCLUSIONS : Distinct AA patient subgroups with substantial differences in healthcare costs were identified. Notably, highest cost subgroups were predominantly female, included >10% AT/AU and higher comorbidity burden. Future studies should further investigate the association of heterogeneity in patient characteristics with healthcare costs.