Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
Eli Lilly and Company (Taiwan), Inc, Taipei, Taiwan.
Value Health Reg Issues. 2024 Sep;43:101007. doi: 10.1016/j.vhri.2024.101007. Epub 2024 Jun 11.
This study investigated the epidemiology, treatment patterns, and resource utilization in patients with alopecia areata (AA) in Taiwan using the National Health Insurance Research Database. AA severity was determined by treatment use and diagnostic codes in the year after enrollment (including corticosteroids, systemic immunosuppressants, topical immunotherapy, and phototherapy).
The cross-sectional analysis was conducted to estimate the incidence and prevalence of AA from 2016 to 2020. For the longitudinal analysis, 2 cohorts were identified: mild/moderate and severe. The cohorts were matched based on age, gender, and comorbidities. Patients were enrolled upon their first claim with an AA diagnosis during the index period of 2017-2018.
The number of patients with AA increased from 3221 in 2016 to 3855 in 2020. The longitudinal analysis identified 1808 mild/moderate patients and 452 severe patients. Mild/moderate patients used higher levels of topical corticosteroids (82.41%) than severe patients (73.45%). Conversely, severe patients used more topical nonsteroids (41.81%) and systemic therapies (51.77%) than mild/moderate patients (0.44% and 16.15%, respectively). Oral glucocorticoids use was higher in severe patients (47.57%) relative to mild/moderate patients (14.88%), whereas the use of injectable forms was similar. The most used systemic immunosuppressants were methotrexate, cyclosporin, and azathioprine. Topical immunotherapy utilization decreased with subsequent treatment lines for severe patients. Treatment persistence at 6 months was low for all treatments. Severe patients had higher annual AA-related outpatient visits than the mild/moderate cohort.
These findings highlight the need for additional innovations and therapies to address the clinical and economic burden of AA.
本研究使用全民健康保险研究数据库调查了台湾斑秃（AA）患者的流行病学、治疗模式和资源利用情况。AA 的严重程度通过入组后一年的治疗使用情况和诊断代码来确定（包括皮质类固醇、全身免疫抑制剂、局部免疫疗法和光疗）。
采用横断面分析方法估计 2016 年至 2020 年 AA 的发病率和患病率。对于纵向分析，确定了两个队列：轻度/中度和重度。根据年龄、性别和合并症对队列进行匹配。患者在 2017-2018 年索引期内首次出现 AA 诊断时入组。
AA 患者人数从 2016 年的 3221 人增加到 2020 年的 3855 人。纵向分析确定了 1808 例轻度/中度患者和 452 例重度患者。轻度/中度患者使用更高水平的局部皮质类固醇（82.41%），而重度患者（73.45%）则使用较少的局部皮质类固醇。相反，重度患者比轻度/中度患者更多地使用局部非甾体类药物（41.81%）和全身治疗（51.77%）（分别为 0.44%和 16.15%）。重度患者口服糖皮质激素使用率（47.57%）高于轻度/中度患者（14.88%），而注射剂型的使用率相似。最常用的全身免疫抑制剂是甲氨蝶呤、环孢素和硫唑嘌呤。对于重度患者，局部免疫疗法的使用率随着后续治疗线而降低。所有治疗方法的 6 个月治疗持续性都较低。重度患者的 AA 相关年门诊就诊次数高于轻度/中度队列。
这些发现强调需要创新和治疗方法来解决 AA 的临床和经济负担。
