Economic Burden of Generalized Pustular Psoriasis: A Population-based Register Study in Finland

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Abstract
Generalized pustular psoriasis is an inflammatory disease characterized by potentially life-threatening flares. This study assessed the economic burden of generalized pustular psoriasis in Finland by comparing healthcare resource utilization and both direct and indirect costs to population-based and psoriasis vulgaris control groups and between generalized pustular psoriasis patients with and without flares. Patients with ≥ 2 generalized pustular psoriasis diagnoses (ICD-10: L40.1) at a dermatology clinic in secondary healthcare and matched controls were identified during 1996–2019 from national registers. Direct costs were based on primary and secondary healthcare resource utilization and medications, and indirect costs on productivity loss due to sick leaves, disability pensions, and rehabilitation periods. All-cause annual direct costs were 3-fold higher in generalized pustular psoriasis (mean: €10,323) compared with population-based (€3,345; p < 0.001), and psoriasis vulgaris controls (€3,569; p < 0.001). Having flares was associated with 2.7-fold higher direct costs compared with no flares (cost ratio 2.7; 95% CI, 2.1–3.5; p < 0.001), driven by higher hospitalization rates of patients with flares. Flares were also associated with 2.5-fold higher indirect costs (cost ratio 2.5; 95% CI, 1.6–4.0; p < 0.001) compared with no flares. This first comprehensive economic evaluation of generalized pustular psoriasis highlights the substantial economic impact, in particular in patients with flares, and emphasizes costs due to work disability.

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