Top

Quality of Life Research

Published in:

Open Access 29-03-2024 | Alopecia Areata

Estimation of health utility values for alopecia areata

Authors: Daniel Aggio, Caleb Dixon, Ernest H. Law, Rowena Randall, Thomas Price, Andrew Lloyd

Published in: Quality of Life Research | Issue 6/2024

Abstract

Purpose

Alopecia areata (AA) is an autoimmune-mediated inflammatory dermatological disease characterised by non-scarring hair loss affecting the scalp and sometimes other hair-bearing sites. This study aimed to elicit health state utility values (HSUVs) from the UK general population for AA using time trade off (TTO) interviews.

Methods

Vignette descriptions of health states defined by the extent of hair loss were developed (as well as one describing caregiver burden). These were developed using data from standardised patient reported outcome (PRO) measures, a literature review and qualitative interviews. Health states were defined based on the severity of alopecia tool (SALT), which assesses extensiveness of scalp hair loss. HSUVs were then elicited for each health state in TTO interviews with the UK public.

Results

One caregiver and five patient health states were developed based on the literature review findings, clinical trial PRO (Hospital Anxiety and Depression Scale and Alopecia Areata Patient Priority Outcomes Questionnaire) data and qualitative interviews with patients (N = 11), clinical experts (N = 4) and caregivers of adolescents with AA (N = 10). These data showed a more severe impact among patients with more extensive hair loss. One hundred and twenty participants evaluated the vignettes in TTO interviews. Patient HSUVs ranged from 0.502 for the most extensive hair loss health state (SALT 50–100 + eyebrow and eyelash loss) to 0.919 (SALT 0–10) for the mildest health state. The caregiver HSUV was 0.882.

Conclusion

Quantitative and qualitative data sources were used to develop and validate vignettes describing different AA health states. Patient and caregiver HSUVs demonstrate a large impact associated with AA, especially for states defined by more extensive hair loss.

Available only for authorised users

Pratt, C. H., King, L. E., Messenger, A. G., Christiano, A. M., & Sundberg, J. P. (2017). Alopecia areata. Nature Reviews Disease Primers, 3, 1.CrossRef

Cranwell, W. C., Lai, V. W., Photiou, L., Meah, N., Wall, D., Rathnayake, D., Joseph, S., Chitreddy, V., Gunatheesan, S., Sindhu, K., & Sharma, P. (2019). Treatment of alopecia areata: An Australian expert consensus statement. Australasian Journal of Dermatology, 60(2), 163–170.PubMedCrossRef

Olsen, E. A., Hordinsky, M. K., Price, V. H., Roberts, J. L., Shapiro, J., Canfield, D., Duvic, M., King, L. E., McMichael, A. J., Randall, V. A., & Turner, M. L. (2004). Alopecia areata investigational assessment guidelines–Part II. Journal of the American Academy of Dermatology, 51(3), 440–447.PubMedCrossRef

Alopecia areata—Level 3 cause | Institute for Health Metrics and Evaluation. Retrieved November 1, 2021 from http://www.healthdata.org/results/gbd_summaries/2019/alopecia-areata-level-3-cause

Harries, M., Macbeth, A. E., Holmes, S., Chiu, W. S., Gallardo, W. R., Nijher, M., de Lusignan, S., Tziotzios, C., & Messenger, A. G. (2022). The epidemiology of alopecia areata: A population-based cohort study in UK primary care. British Journal of Dermatology, 186(2), 257.PubMedCrossRef

Villasante Fricke, A. C., & Miteva, M. (2015). Epidemiology and burden of alopecia areata: A systematic review. Clinical Cosmetic and Investigational Dermatology, 2015, 397–403.

Mostaghimi, A., Napatalung, L., Sikirica, V., Winnette, R., Xenakis, J., Zwillich, S. H., & Gorsh, B. (2021). Patient perspectives of the social, emotional and functional impact of alopecia areata: A systematic literature review. Dermatology and Therapy, 11, 867–883. https://doi.org/10.1007/s13555-021-00512-0CrossRefPubMedPubMedCentral

Rencz, F., Gulácsi, L., Péntek, M., Wikonkál, N., Baji, P., & Brodszky, V. (2016). Alopecia areata and health-related quality of life: A systematic review and meta-analysis. British Journal of Dermatology., 175(3), 561–571. https://doi.org/10.1111/bjd.14497CrossRefPubMed

Janković, S., Perić, J., Maksimović, N., Ćirković, A., Marinković, J., Janković, J., Reljić, V., & Medenica, L. (2016). Quality of life in patients with alopecia areata: A hospital-based cross-sectional study. Journal of the European Academy of Dermatology and Venereology, 30(5), 840–846. https://doi.org/10.1111/jdv.13520CrossRefPubMed

10.

Winnette, R., Martin, S., Harris, N., & Deal, L. S. (2021). Development of the alopecia areata patient priority outcomes instrument: A qualitative study. Dermatology and Therapy, 11, 599–613.PubMedPubMedCentralCrossRef

11.

Welsh, N., & Guy, A. (2009). The lived experience of alopecia areata: A qualitative study. Body Image, 6(3), 194–200.PubMedCrossRef

12.

Masmoudi, J., Sellami, R., Ouali, U., Mnif, L., Feki, I., Amouri, M., et al. (2013). Quality of life in alopecia areata: A sample of Tunisian patients. Dermatology Research and Practice. https://doi.org/10.1155/2013/983804CrossRefPubMedPubMedCentral

13.

Liu, L. Y., King, B. A., & Craiglow, B. G. (2016). Health-related quality of life (HRQoL) among patients with alopecia areata (AA): A systematic review. Journal of the American Academy of Dermatology, 75(4), 806–812.PubMedCrossRef

14.

Li, S. J., Huang, K. P., Joyce, C., & Mostaghimi, A. (2018). The impact of alopecia areata on sexual quality of life. International Journal of Trichology, 10(6), 271–274.PubMedPubMedCentralCrossRef

15.

Aldhouse, N. V., Kitchen, H., Knight, S., Macey, J., Nunes, F. P., Dutronc, Y., Mesinkovska, N., Ko, J. M., King, B. A., & Wyrwich, K. W. (2020). “‘You lose your hair, what’s the big deal?’I was so embarrassed, I was so self-conscious, I was so depressed:” A qualitative interview study to understand the psychosocial burden of alopecia areata. Journal of Patient-Reported Outcomes, 4(1), 76. https://doi.org/10.1186/s41687-020-00240-7CrossRefPubMedPubMedCentral

16.

Titeca, G., Goudetsidis, L., Francq, B., Sampogna, F., Gieler, U., Tomas-Aragones, L., Lien, L., Jemec, G. B., Misery, L., Szabó, C., & Linder, D. (2020). ‘The psychosocial burden of alopecia areata and androgenetica’: A cross-sectional multicentre study among dermatological out-patients in 13 European countries. Journal of the European Academy of Dermatology and Venereology, 34(2), 406–411.PubMedCrossRef

17.

Messenger, A. G., McKillop, J., Farrant, P., McDonagh, A. J., Sladden, M., Hughes, J., McLelland, J., Punjabi, S., Buckley, D. A., Nasr, I., & Swale, V. J. (2012). British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. British Journal of Dermatology, 166(5), 916–926.PubMedCrossRef

18.

Yan, D., Fan, H., Chen, M., & Nie, X. (2022). The efficacy and safety of JAK inhibitors for alopecia areata: A systematic review and meta-analysis of prospective studies. Frontiers in Pharmacology, 13, 950450.PubMedPubMedCentralCrossRef

19.

A phase 3 study to evaluate the efficacy and safety of CTP-543 in adult patients with moderate to severe alopecia areata (THRIVE-AA2)—full text view. ClinicalTrials.gov. Retrieved March 3, 2023 from https://clinicaltrials.gov/ct2/show/NCT04797650

20.

A study of Baricitinib (LY3009104) in adults with severe or very severe alopecia areata-full text view-ClinicalTrials.gov. Retrieved March 3, 2023 from https://clinicaltrials.gov/ct2/show/NCT03899259

21.

PF-06651600 for the treatment of alopecia areata-full text view-ClinicalTrials.gov. Retrieved March 3, 2023 from https://clinicaltrials.gov/ct2/show/NCT03732807

22.

NICE health technology evaluations: The manual process and methods. Retrieved November 10, 2022 from www.nice.org.uk/process/pmg36

23.

Overview | Baricitinib for treating moderate to severe atopic dermatitis | Guidance | NICE. Retrieved March 26, 2023 from https://www.nice.org.uk/guidance/ta681

24.

Bewley, A., Galván, S. V., Johansson, E., Austin, J., Durand, F., Petto, H., Piraccini, B. M., & Blume-Peytavi, U. (2022). PCR200 measuring the burden of alopecia areata with the European quality of life-5 dimensions (EQ-5D): Results from a real-world survey in 5 European countries. Value in Health, 25(12), S428–S429.CrossRef

25.

Burge, R. T., Anderson, P., Austin, J., Piercy, J., Manuel, L., Edson-Heredia, E., McCollam, J. S., & Senna, M. (2021). The patient-reported burden of alopecia areata by current severity: A real-world study in the US. Journal of the American Academy of Dermatology, 85(3), AB86.CrossRef

26.

Rowen, D., Brazier, J., Wong, R., & Wailoo, A. (2020). Measuring and valuing health-related quality of life when sufficient EQ-5D data is not available. NICE DSU Rep, 7, 1–48.

27.

Matza, L. S., Stewart, K. D., Lloyd, A. J., Rowen, D., & Brazier, J. E. (2021). Vignette-based utilities: Usefulness, limitations, and methodological recommendations. Value in Health, 24(6), 812–821.PubMedCrossRef

28.

Brazier, J., & Rowen, D. (2017). NICE DSU technical support document 11: Alternatives to EQ-5D for generating health state utility values. London: NICE.

29.

King, B., Zhang, X., Harcha, W. G., Szepietowski, J. C., Shapiro, J., Lynde, C., Mesinkovska, N. A., Zwillich, S. H., Napatalung, L., Wajsbrot, D., & Fayyad, R. (2023). Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: A randomised, double-blind, multicentre, phase 2b–3 trial. The Lancet, 401(10387), 1518–1529.CrossRef

30.

Hauber, B., Whichello, C., Mauer, J., Law, E., Trapali, M., Whalen, E. P., Wajsbrot, D., Krucien, N., Tervonen, T., Zwillich, S., & Wolk, R. (2022). PCR63 using patient preference to inform ritlecitinib dose selection for alopecia areata treatment. Value in Health, 25(12), S402.CrossRef

31.

Snaith, R. P. (2003). The hospital anxiety and depression scale. Health and Quality of Life Outcomes, 1, 1–4.CrossRef

32.

Wyrwich, K. W., Winnette, R., Bender, R., Gandhi, K., Williams, N., Harris, N., & Nelson, L. (2022). Validation of the alopecia areata patient priority outcomes (AAPPO) questionnaire in adults and adolescents with alopecia areata. Dermatology and Therapy, 12(1), 149–166.PubMedCrossRef

33.

2011 Census—Office for National Statistics. Retrieved August 22, 2022 from https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/2011censuspopulationestimatesfortheunitedkingdom/2012-12-17

34.

Oppe, M., Rand-Hendriksen, K., Shah, K., Ramos-Goñi, J. M., & Luo, N. (2016). EuroQol protocols for time trade-off valuation of health outcomes. PharmacoEconomics, 34, 993–1004.PubMedPubMedCentralCrossRef

35.

Devlin, N. J., Tsuchiya, A., Buckingham, K., & Tilling, C. (2011). A uniform time trade off method for states better and worse than dead: feasibility study of the ‘lead time’approach. Health Economics, 20(3), 348–361.PubMedCrossRef

36.

1.13 Citing R | An introduction to R. Retrieved January 13, 2023 from https://intro2r.com/citing-r.html

37.

Package “eq5d” type package title methods for analysing “EQ-5D” data and calculating “EQ-5D” index scores. Retrieved January 13, 2023 from https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/

38.

Macey, J., Kitchen, H., Aldhouse, N. V., Burge, R. T., Edson-Heredia, E., McCollam, J. S., Isaka, Y., & Torisu-Itakura, H. (2021). Dermatologist and patient perceptions of treatment success in alopecia areata and evaluation of clinical outcome assessments in Japan. Dermatology and Therapy, 11, 433–447.PubMedPubMedCentralCrossRef

39.

Ghajarzadeh, M., Ghiasi, M., & Kheirkhah, S. (2011). Depression and quality of life in Iranian patients with alopecia areata. Iranian Journal of Dermatology, 14(4), 140–143.

40.

Chernyshov, P. V., Tomas-Aragones, L., Finlay, A. Y., Manolache, L., Marron, S. E., Sampogna, F., Spillekom-van Koulil, S., Pustisek, N., Suru, A., Evers, A. W. M., & Salavastru, C. (2021). Quality of life measurement in alopecia areata: Position statement of the European Academy of dermatology and venereology task force on quality of life and patient oriented outcomes. Journal of the European Academy of Dermatology and Venereology, 35(8), 1614–1621.PubMedCrossRef

41.

de Vere Hunt, I., McNiven, A., & McPherson, T. (2021). A qualitative exploration of the experiences of adolescents with alopecia areata and their messages for healthcare professionals. British Journal of Dermatology, 184(3), 557–559.PubMedCrossRef

42.

Okhovat, J. P., Marks, D. H., Manatis-Lornell, A., Hagigeorges, D., Locascio, J. J., & Senna, M. M. (2023). Association between alopecia areata, anxiety, and depression: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 88(5), 1040–1050.PubMedCrossRef

43.

Liu, L. Y., King, B. A., & Craiglow, B. G. (2018). Alopecia areata is associated with impaired health-related quality of life: A survey of affected adults and children and their families. Journal of the American Academy of Dermatology, 79(3), 556–558.PubMedCrossRef

44.

Rodgers, A. R. (2018). Why finding a treatment for alopecia areata is important: A multifaceted perspective. Journal of Investigative Dermatology Symposium Proceedings., 19(1), S51–S53.PubMedCrossRef

45.

(PDF) Impact on quality of life of family members of vitiligo patients in North India: A cross-sectional study using family dermatology life quality index. Retrieved February 1, 2023 from https://www.researchgate.net/publication/355264516_Impact_on_quality_of_life_of_family_members_of_vitiligo_patients_in_North_India_A_cross-sectional_study_using_family_dermatology_life_quality_index

46.

Putterman, E., Patel, D. P., Andrade, G., Harfmann, K. L., Hogeling, M., Cheng, C. E., Goh, C., Rogers, R. S., & Castelo-Soccio, L. (2019). Severity of disease and quality of life in parents of children with alopecia areata, totalis, and universalis: A prospective, cross-sectional study. Journal of the American Academy of Dermatology, 80(5), 1389–1394.PubMedCrossRef

47.

Census—Office for National Statistics. Retrieved October 2023. https://www.ons.gov.uk/census

48.

Janssen, B., Szende, A., Janssen, B., & Szende, A. (2014). Self-reported population health: An international perspective based on EQ-5D. Springer.

49.

Andersen, L., Nyeland, M. E., & Nyberg, F. (2020). Higher self-reported severity of atopic dermatitis in adults is associated with poorer self-reported health-related quality of life in France, Germany, the UK and the USA. British Journal of Dermatology, 182(5), 1176–1183.PubMedCrossRef

50.

Heinz, K. C., Willems, D., & Hiligsmann, M. (2022). Economic evaluation of a JAK inhibitor compared to a monoclonal antibody for treatment of moderate-to-severe atopic dermatitis from a UK perspective. Journal of Medical Economics, 25(1), 491–502. https://doi.org/10.1080/13696998.2022.2059220CrossRefPubMed

51.

Mavranezouli, I., Welton, N. J., Daly, C. H., Wilcock, J., Bromham, N., Berg, L., Xu, J., Wood, D., Ravenscroft, J. C., Dworzynski, K., & Healy, E. (2022). Cost-effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Clinical and Experimental Dermatology, 47(12), 2176–2187.PubMedPubMedCentralCrossRef

52.

Final appraisal determination-Omalizumab for previously treated chronic spontaneous urticaria. Retrieved 24 February, 2024 from https://www.nice.org.uk/guidance/ta339

53.

Hollis, K., Abuzakouk, M., Balp, M., Berard, F., Canonica, G. W., Gimenez-Arnau, A., Grattan, C., Khalil, S., Knulst, A. C., Lacour, J., & Lynde, C. (2016). Assessing health-utility values for chronic spontaneous/idiopathic urticaria in real-world using the EQ-5D: Results from assure-Csu study. Value in Health, 19(7), A570–A571.CrossRef

54.

Yuan, Y., Xiao, Y., Chen, X., Li, J., & Shen, M. (2020). A systematic review and meta-analysis of health utility estimates in chronic spontaneous urticaria. Frontiers in Medicine, 7, 543290.PubMedPubMedCentralCrossRef

55.

Vañó-Galván, S., Blume-Peytavi, U., Farrant, P., Reygagne, P., Johansson, E., Reed, C., Marwaha, S., Durand, F., & Piraccini, B. M. (2023). Physician-and patient-reported severity and quality of life impact of alopecia areata: Results from a real-world survey in five European countries. Dermatology and Therapy, 13(12), 3121–3135.PubMedPubMedCentralCrossRef

56.

Davey, L., Clarke, V., & Jenkinson, E. (2019). Living with alopecia areata: An online qualitative survey study. British Journal of Dermatology, 180(6), 1377–1389.PubMedCrossRef

57.

Mesinkovska, N., King, B., Mirmirani, P., Ko, J., & Cassella, J. (2020). Burden of illness in alopecia areata: A cross-sectional online survey study. Journal of Investigative Dermatology Symposium Proceedings., 20(1), S62–S68.PubMedCrossRef

58.

Rafique, R., & Hunt, N. (2015). Experiences and coping behaviours of adolescents in Pakistan with alopecia areata: An interpretative phenomenological analysis. International Journal of Qualitative Studies on Health and Well-being, 10(1), 26039.PubMedCrossRef

59.

Toussi, A., Barton, V. R., Le, S. T., Agbai, O. N., & Kiuru, M. (2021). Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review. Journal of the American Academy of Dermatology, 85(1), 162–175.PubMedCrossRef

Title: Estimation of health utility values for alopecia areata
Authors: Daniel Aggio
Caleb Dixon
Ernest H. Law
Rowena Randall
Thomas Price
Andrew Lloyd
Publication date: 29-03-2024
Publisher: Springer International Publishing
Keyword: Alopecia Areata
Published in: Quality of Life Research / Issue 6/2024
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-024-03645-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Estimation of health utility values for alopecia areata

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2024

The quality of life impact of the COVID-19 pandemic and lockdowns for people living with multiple sclerosis (MS): evidence from the Australian MS Longitudinal Study

Symptom profiles in patients receiving maintenance hemodialysis and their association with quality of life: a longitudinal study

Patient adherence and response time in electronic patient-reported outcomes: insights from three longitudinal clinical trials

Association between sleep quality and quality of life in Singapore

Quality of life, cognitive and behavioural impairment in people with motor neuron disease: a systematic review

Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: results from the D-CLIP trial