{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:11:01Z","timestamp":1779394261707,"version":"3.53.1"},"reference-count":47,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alopecia areata (AA) is a chronic autoimmune condition characterized by non-scarring hair loss, with significant psychological, social, and economic implications. In Saudi Arabia, AA prevalence ranges from 2.3% to 13.8%, with early onset and strong familial predisposition. Despite its burden, data on the economic impact of AA in the region remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"objectives\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study assessed the economic burden of AA in the Kingdom of Saudi Arabia from both public payer and societal perspectives, across varying disease severities including mild to moderate, severe, and refractory cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prevalence-based cost-of-illness model was developed using structured literature review, expert input, and primary data collection via questionnaires. The model estimated direct medical costs (drug acquisition, diagnostics, clinic visits), direct nonmedical costs (travel, accommodation), and indirect costs (productivity loss) over 1 year for mild to severe AA and 2 years for refractory cases. Cost data were sourced from official channels (National Unified Procurement Company and the Saudi Food and Drug Authority) and validated using Saudi Amazon and Al-Dawaa pharmacy platforms. Medical costs, including laboratory tests, diagnostic procedures, and all supportive therapies, were obtained from the Ministry of Health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average annual per-patient cost was SAR 20\u2009703 for mild to moderate AA and SAR 76\u2009957 for severe AA, translating into SAR 5.827 billion and SAR 3.352 billion total burden, respectively. Refractory AA cases incurred cumulative 2-year costs ranging from SAR 102\u2009117 to SAR 167\u2009615 per patient. Indirect costs, primarily due to productivity loss, were the dominant cost driver in mild to moderate AA and remained substantial across all severities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"discussion\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Indirect costs, mainly productivity loss, drive the economic burden of AA in Saudi Arabia, with drug costs rising in severe cases. This pattern mirrors findings from global studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AA imposes a significant financial burden in Saudi Arabia, driven largely by productivity losses and drug acquisition costs. These findings underscore the need for early diagnosis, standardized treatment protocols, and improved access to innovative therapies. Integrated care pathways and national registries are essential to optimize resource allocation and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36469\/001c.151864","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T14:46:02Z","timestamp":1766155562000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Economic Burden of Alopecia Areata in the Kingdom of Saudi Arabia from a Societal Perspective: A Cost-of-Illness Analysis"],"prefix":"10.36469","volume":"12","author":[{"given":"Khalidah","family":"Alenzi","sequence":"first","affiliation":[{"name":"Tabuk Health Cluster, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Alturaiki","sequence":"additional","affiliation":[{"name":"Ministry of the National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Fatani","sequence":"additional","affiliation":[{"name":"Hera General Hospital, Makkah, Saudi Arabia","department":["Dermatology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Alsogair","sequence":"additional","affiliation":[{"name":"Dr. Layla AlOnaizi Polyclinic, Khobar, Saudi Arabia","department":["Department of Dermatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsalan Mohammad","family":"Saeed","sequence":"additional","affiliation":[{"name":"Pfizer Scientific Technical Limited Company, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Behiry","sequence":"additional","affiliation":[{"name":"Pfizer Scientific Technical Limited Company, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Almomatin","sequence":"additional","affiliation":[{"name":"Pfizer Scientific Technical Limited Company, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"publisher","first-page":"e49864","DOI":"10.7759\/cureus.49864","article-title":"Assessing the impact of alopecia on quality of life, depression, and self-esteem in Saudi Arabia","volume":"15","author":"N. M. Alzoabi","year":"2023","journal-title":"Cureus"},{"issue":"4","key":"ref2","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s13555-022-00710-4","article-title":"Economic burden and healthcare resource use of alopecia areata in an insured population in the USA","volume":"12","author":"A. Mostaghimi","year":"2022","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"9","key":"ref3","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1111\/1346-8138.17381","article-title":"A retrospective analysis of disease epidemiology, comorbidities, treatment patterns, and healthcare resource utilization of alopecia areata in the United Arab Emirates using claims database","volume":"51","author":"A. A. Hammadi","year":"2024","journal-title":"J Dermatol"},{"issue":"10","key":"ref4","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1111\/1346-8138.16888","article-title":"Economic burden of alopecia areata: a study of direct and indirect cost in Japan using real-world data","volume":"50","author":"M. Ohyama","year":"2023","journal-title":"J Dermatol"},{"issue":"1","key":"ref5","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s13555-022-00857-0","article-title":"Humanistic and economic burden of atopic dermatitis for adults and adolescents in the Middle East and Africa Region","volume":"13","author":"B. Elezbawy","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"1","key":"ref6","doi-asserted-by":"publisher","first-page":"e301","DOI":"10.1002\/ski2.301","article-title":"Establishing the financial burden of alopecia areata and its predictors","volume":"4","author":"F. Zucchelli","year":"2024","journal-title":"Skin Health Dis"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.20944\/preprints202401.0861.v1","article-title":"The economic burden of alopecia areata in Romania","author":"S. Strilciuc","year":"2024"},{"issue":"10","key":"ref8","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1007\/s13555-023-00991-3","article-title":"Diagnosis and management of alopecia areata: a Saudi Expert Consensus Statement (2023)","volume":"13","author":"M. I. A. Fatani","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e18743722280092","DOI":"10.2174\/0118743722280092240126053902","article-title":"Insights into alopecia areata: a systematic review of prevalence, pathogenesis, and psychological consequences","volume":"18","author":"E. A. M. Bahashwan","year":"2024","journal-title":"Open Dermatol J"},{"issue":"4","key":"ref10","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1001\/jamadermatol.2023.0002","article-title":"Trends in prevalence and incidence of alopecia areata, alopecia totalis, and alopecia universalis among adults and children in a US employer-sponsored insured population","volume":"159","author":"A. Mostaghimi","year":"2023","journal-title":"JAMA Dermatol"},{"issue":"2","key":"ref11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.4103\/ijt.ijt_99_17","article-title":"Alopecia areata: review of epidemiology, clinical features, pathogenesis, and new treatment options","volume":"10","author":"E. Darwin","year":"2018","journal-title":"Int J Trichol"},{"key":"ref12","article-title":"GASTAT Portal","year":"2023","journal-title":"Saudicensus.sa"},{"issue":"8","key":"ref13","doi-asserted-by":"publisher","first-page":"1801","DOI":"10.1007\/s13555-023-00963-7","article-title":"Treatment patterns and unmet needs in the management of alopecia areata: results of a physician's survey in the Middle East","volume":"13","author":"A. Ammoury","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"3","key":"ref14","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/14656566.2020.1854728","article-title":"Are drug treatment strategies really effective against alopecia areata?","volume":"22","author":"T. Rattananukrom","year":"2021","journal-title":"Expert Opin Pharmacother"},{"issue":"1","key":"ref15","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s13555-022-00864-1","article-title":"The association of alopecia areata-related emotional symptoms with work productivity and daily activity among patients with alopecia areata","volume":"13","author":"K. Gandhi","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"suppl 1","key":"ref16","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.abd.2020.05.006","article-title":"Consensus on the treatment of alopecia areata\u2013Brazilian Society of Dermatology","volume":"95","author":"P. M. Ramos","year":"2020","journal-title":"An Bras Dermatol"},{"issue":"9","key":"ref17","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1007\/s40265-023-01873-w","article-title":"Baricitinib for the treatment of alopecia areata","volume":"83","author":"E. Freitas","year":"2023","journal-title":"Drugs"},{"key":"ref18","article-title":"Alopecia areata gets FDA-approved drug","author":"I. Petrou","year":"2022","journal-title":"Dermatol Times"},{"key":"ref19","article-title":"Baricitinib recommended for approval of severe alopecia areata in Europe","author":"D. Brunk","year":"2022","journal-title":"Medscape"},{"key":"ref20","article-title":"European Commission approves once-daily olumiant tablets for treatment of adults with moderate-to-severe active rheumatoid arthritis","year":"2017"},{"key":"ref21","article-title":"Olumiant\u00ae (baricitinib) tablets: Prescribing guidance for atopic dermatitis and alopecia areata"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"397","DOI":"10.2147\/CCID.S53985","article-title":"Epidemiology and burden of alopecia areata: a systematic review","volume":"8","author":"A.C. Villasante Fricke","year":"2015","journal-title":"Clin Cosmet Investig Dermatol"},{"issue":"18","key":"ref23","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1056\/NEJMoa2110343","article-title":"Two phase 3 trials of baricitinib for alopecia areata","volume":"386","author":"B. King","year":"2022","journal-title":"N Engl J Med"},{"issue":"7","key":"ref24","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1007\/s13555-023-00946-8","article-title":"Review on alopecia areata in the Middle East and Africa: landscape and unmet needs","volume":"13","author":"A. Al Hammadi","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"2","key":"ref25","doi-asserted-by":"publisher","first-page":"125","DOI":"10.4103\/2278-0521.157891","article-title":"Prevalence and treatment of alopecia areata in Taif area, KSA","volume":"4","author":"A. M. A. Abd El-Mawla","year":"2015","journal-title":"Saudi J Health Sci"},{"issue":"2","key":"ref26","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.jaad.2009.10.031","article-title":"Alopecia areata update: part II. Treatment","volume":"62","author":"A. Alkhalifah","year":"2010","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"ref27","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.jaad.2018.06.064","article-title":"Methotrexate for alopecia areata: a systematic review and meta-analysis","volume":"80","author":"K. Phan","year":"2019","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"ref28","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jssdds.2013.05.004","article-title":"Alopecia areata: a review","volume":"17","author":"S. S. Amin","year":"2013","journal-title":"J Saudi Soc Dermatol Dermatol Surg"},{"issue":"6","key":"ref29","doi-asserted-by":"publisher","first-page":"e13958","DOI":"10.1111\/eci.13958","article-title":"Global, regional and national burden of alopecia areata and its associated diseases, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019","volume":"53","author":"H. Jang","year":"2023","journal-title":"Eur J Clin Invest"},{"issue":"4","key":"ref30","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.1097\/JW9.0000000000000118","article-title":"The financial burden of alopecia: a survey study","volume":"9","author":"J. P. Ingrassia","year":"2023","journal-title":"Int J Womens Dermatol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"adv00838","DOI":"10.2340\/actadv.v103.4441","article-title":"Out-of-pocket costs in alopecia areata: a cross-sectional study in German-speaking countries","volume":"103","author":"J. Kullab","year":"2023","journal-title":"Acta Derm Venereol"},{"issue":"5","key":"ref32","first-page":"39","article-title":"Pharmacotherapy options for alopecia areata","volume":"49","author":"K. Hale","year":"2024","journal-title":"US Pharmacist"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"7194270","DOI":"10.1155\/2020\/7194270","article-title":"Prevalence and clinical characteristics of alopecia areata at a tertiary care center in Saudi Arabia","volume":"2020","author":"A. A. Alshahrani","journal-title":"Dermatol Res Pract"},{"key":"ref34","article-title":"Alopecia areata","author":"K. Lepe","year":"2025","journal-title":"StatPearls"},{"issue":"6","key":"ref35","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1046\/j.1365-4362.2003.01340.x","article-title":"Alopecia areata: psychiatric comorbidity and adjustment to illness","volume":"42","author":"S. Ruiz-Doblado","year":"2003","journal-title":"Int J Dermatol"},{"issue":"1","key":"ref36","doi-asserted-by":"publisher","first-page":"e77317","DOI":"10.7759\/cureus.77317","article-title":"Integrating psychological support and topical therapy for the effective management of stress-induced alopecia areata: a case report","volume":"17","author":"A. A. Alotiby","year":"2025","journal-title":"Cureus"},{"issue":"3","key":"ref37","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12030964","article-title":"Systematic review of psychological interventions for quality of life, mental health, and hair growth in alopecia areata and scarring alopecia","volume":"12","author":"J. Maloh","year":"2023","journal-title":"J Clin Med"},{"issue":"4","key":"ref38","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1001\/jamadermatol.2020.5732","article-title":"Evaluation of stigma toward individuals with alopecia","volume":"157","author":"A. Creadore","year":"2021","journal-title":"JAMA Dermatol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.jdin.2022.12.003","article-title":"Addressing the psychosocial burden of alopecia areata in clinical practice","volume":"10","author":"R. Hirani","year":"2023","journal-title":"JAAD Int"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"803","DOI":"10.2147\/CCID.S376096","article-title":"Alopecia areata: burden of disease, approach to treatment, and current unmet needs","volume":"16","author":"L. Alhanshali","year":"2023","journal-title":"Clin Cosmet Investig Dermatol"},{"issue":"5","key":"ref41","doi-asserted-by":"publisher","first-page":"e098802","DOI":"10.1136\/bmjopen-2025-098802","article-title":"Identifying barriers and disparities in the healthcare of patients with alopecia areata: a mixed-methods analysis using claims data and qualitative interview data","volume":"15","author":"T. M. Janke","year":"2025","journal-title":"BMJ Open"},{"issue":"9","key":"ref42","doi-asserted-by":"publisher","first-page":"e10347","DOI":"10.7759\/cureus.10347","article-title":"Prevalence of alopecia areata in Saudi Arabia: cross-sectional descriptive study","volume":"12","author":"A. Al-Ajlan","year":"2020","journal-title":"Cureus"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.18848","article-title":"Quality of life in children and adolescents with alopecia areata\u2013a systematic review","author":"M. Prendke","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.18926","article-title":"The burden of alopecia areata: a scoping review focusing on quality of life, mental health and work productivity","author":"A. Muntyanu","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2597","DOI":"10.2147\/PPA.S486039","article-title":"Awareness, beliefs, and psychological impact of patients with alopecia areata in Saudi Arabia: a multi-center study","volume":"18","author":"N. A. Almulhim","year":"2024","journal-title":"Patient Prefer Adherence"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/4286891","article-title":"Evaluation of the awareness, beliefs, and psychological impact of patients with alopecia areata in Makkah City, Saudi Arabia","volume":"4286891","author":"B. A. Alzubaidy","year":"2023","journal-title":"Adv Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e18743722280092","DOI":"10.2174\/0118743722280092240126053902","article-title":"Insights into alopecia areata: a systematic review of prevalence, pathogenesis, and psychological consequences","volume":"18","author":"E. Bahashwan","year":"2024","journal-title":"Open Dermatol J"}],"container-title":["Journal of Health Economics and Outcomes Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jheor.org\/article\/151864-economic-burden-of-alopecia-areata-in-the-kingdom-of-saudi-arabia-from-a-societal-perspective-a-cost-of-illness-analysis","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T19:07:27Z","timestamp":1779390447000},"score":1,"resource":{"primary":{"URL":"https:\/\/jheor.org\/article\/151864-economic-burden-of-alopecia-areata-in-the-kingdom-of-saudi-arabia-from-a-societal-perspective-a-cost-of-illness-analysis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.36469\/001c.151864","relation":{},"ISSN":["2327-2236"],"issn-type":[{"value":"2327-2236","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}