Understanding Work-related Economic Burden Among Adults with Vitiligo in the United States and Europe

Abstract

Background: Vitiligo can or may impose an economic burden on affected individuals and society. People with vitiligo may face employment discrimination, such as exclusion from job opportunities and may experience reduced work productivity. To better quantify this impact, the current study aims to estimate work productivity loss and associated indirect costs among adults with vitiligo in the United States (US) and Europe. 

Methods: Adults (aged ≥18 years) who completed the 2024 National Health and Wellness Survey (NHWS) in US, United Kingdom, Germany, France, Italy, or Spain were recontacted to complete a quantitative cross-sectional online survey. NHWS respondents who self-reported being diagnosed with vitiligo by a physician were eligible for the study. Data from all countries were assessed in aggregate. Variables included sociodemographic and clinical characteristics, vitiligo-specific work productivity loss and activity impairment (Work Productivity and Activity Impairment Questionnaire-Specific Health Problem version; scores range from 0-100%, with higher scores indicating greater impairment), and vitiligo-specific annual indirect costs (US dollar values). Indirect costs were calculated using national wage rates in a given country and the Human Capital Approach. Work and activity impacts and costs were stratified by years since diagnosis (≤5 vs. >5 years), Fitzpatrick skin type (FST, I-II vs. III-VI), patient-reported perception of current vitiligo severity on face and on body (each, none-to-mild vs. moderate-to-very severe), face involvement (vs. none), and percentage body surface area (BSA) with vitiligo (<4% vs. ≥4%). 

Results: 155 adults with vitiligo were included in the analyses. The aggregate sample had a mean age (±standard deviation) of 58.1±15.9 years, with 20.8±17.6 years since vitiligo diagnosis; 51.0% were female, with 37.4% and 58.7% reporting moderate-to-very severe vitiligo currently on face and body, respectively. Participants who were currently employed reported a mean overall work productivity loss of 18.9±33.5% and incurred indirect costs of $6,758±$14,244. Those with ≤5 (vs. >5) years since diagnosis reported significantly higher overall work productivity loss (33.3% vs. 11.8%, p=0.022) and indirect costs ($12,688 vs. $3,738, p=0.037). Moderate-to-very severe vitiligo on the face and on the body (vs. none-to-mild) were associated with significantly higher overall work productivity loss (face: 35.9% vs. 3.1%, p<0.001; body: 26.9% vs. 2.5%, p<0.001) and indirect costs (face: $12,514 vs. $1,551, p<0.001; body: $9,511 vs. $1,356, p=0.002). Those with face involvement (vs. none) reported significantly higher overall work productivity loss (26.8% vs. 4.5%, p<0.001) and total indirect costs ($9,722 vs. $1,547, p=0.002). Work productivity loss and indirect costs were numerically greater for those with BSA ≥4% than those with <4% and those with FST III-VI than those with FST I-II, but not statistically significant. 

Conclusions: Adults with vitiligo reported a substantial work-related economic burden. Shorter disease duration, more severe vitiligo on face and body, and face involvement were associated with substantially more vitiligo-specific work productivity loss and indirect costs. These results underscore the need for vitiligo management strategies aimed at reducing not only visible symptoms, but also perceived severity, early in the patient’s journey to reduce downstream social impacts.