The Invisible Impact of a Visible Disease: Psychosocial Impact of Alopecia Areata.

INTRODUCTION: The physical impact of alopecia areata (AA) is visible, but the psychological and social consequences and emotional burden are often underrecognized. METHODS: In this cross-sectional study, 547 participants recruited via the National Alopecia Areata Foundation completed a survey encompassing demographics; AA illness characteristics; and five patient-reported outcome measures on anxiety and depression, perceived stress, psychological illness impact, stigma, and quality of life (QoL). Differences in disease severity subgroups were assessed via analysis of variance (ANOVA) and t tests. RESULTS: Mean age was 44.6 years, and 76.6% were female. Participants with more severe hair loss tended to report longer duration of experiencing AA symptoms (P < 0.001). Overall, participants reported negative psychological impact, emotional burden, and poor QoL due to AA. Participants with 21-49% or 50-94% scalp hair loss reported greater psychological impact and poorer QoL than those with 95-100% scalp hair loss (most parameters P < 0.05). Similar results were observed for eyebrow/eyelash involvement subgroups. CONCLUSIONS: These results suggest that participants with AA experience emotional burden, negative self-perception, and stigma, but the impact of AA is not dependent solely on the amount of hair loss. Lower impact among participants with 95-100% scalp hair loss may indicate that they have adapted to living with AA.

Comparing the burden of illness in patients with alopecia areata vs atopic dermatitis in the US population from a payer perspective.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. AA frequently co-occurs with other inflammatory autoimmune conditions, presenting a significant clinical burden. OBJECTIVE: To compare the burden of illness, direct and indirect costs in adult patients with AA vs atopic dermatitis (AD). METHODS: This retrospective cohort study used US administrative claims data from the Merative MarketScan Commercial Claims and Encounters Database to compare commercially insured adults with AA to those with AD. Patients with an AA diagnosis between January 2017 and September 2019 were propensity score matched to patients with AD. Comorbidity burden, medication use, health care resource utilization, health care costs, and indirect costs during a 12-month follow-up period were compared between cohorts. RESULTS: Overall, 25,446 adult patients with AA were selected for the matched analysis with the AD cohort. Patients with AA generally had lower comorbidity burden than patients with AD; mean Deyo-Charlson Comorbidity Index scores were 0.36 (SD = 0.99) and 0.39 (SD = 0.92), for AA and AD, respectively (P = 0.007). Patients with AA had significantly lower proportions of allergic rhinitis, asthma, pruritus, skin infections, and urticaria, but higher proportions of thyroid disease, when compared with patients with AD (all P < 0.001). A smaller proportion of patients with AA had prescriptions for topical (45.3% vs 64.8%; P < 0.001) and oral (20.3% vs 29.6%; P < 0.001) corticosteroids and antianxiety and/or antidepressants (24.7% vs 29.7%; P < 0.001), but a significantly larger proportion for intralesional corticosteroids (triamcinolone) (49.6% vs 21.7%; P < 0.001), compared with patients with AD. Despite a lower comorbidity burden and generally less medication usage in patients with AA, total all-cause health care costs did not significantly differ between the AA and AD cohorts ($10,705 vs $10,816; P = 0.712), and outpatient costs were higher in patients with AA ($6,297 vs $5,859; P = 0.014). Female patients with AA had significantly greater costs for both outpatient and outpatient pharmacy when compared with female patients with AD. Patients with AA were more likely to have a claim for long-term disability (0.6% vs 0.3%; P = 0.001) and higher long-term disability-associated indirect costs ($73 [SD = $1,442] vs $25 [SD = $774]; P = 0.004) compared with patients with AD. CONCLUSIONS: We found similar total health care costs in patients with AA and AD, despite a lower proportion of comorbidities and prescription use in patients with AA. Outpatient costs were also significantly higher overall in patients with AA. Although often dismissed as a cosmetic condition, AA, an autoimmune disease, has a similar level of medical expenditure as AD. DISCLOSURES: This study was funded by Eli Lilly and Company. Mr Fenske and Drs Ding, Morrow, and Smith are employed by Eli Lilly and Company. Drs Manjelievskaia, Moynihan, and Silver are employed by Merative. Drs Manjelievskaia, Moynihan, and Silver were employed by IBM Watson Health at the time of study completion. IBM Watson Health received funding from Eli Lilly and Company to conduct this study.

Economic burden and risk factors of migraine disease progression in the US: a retrospective analysis of a commercial payer database.

AIMS: To evaluate the prevalence and risk factors of migraine progression and to assess the incremental burden of migraine progression on healthcare systems. MATERIALS AND METHODS: Adult patients were required to have a migraine diagnosis in IQVIA's US adjudicated claims database between 1 January 2012 and 30 June 2016, continuous enrollment ≥12 months before and after the index date (i.e. the first observed migraine diagnosis), and ≥1 additional migraine diagnosis claim during the 12-month post-index period. A previously-developed algorithm identified patients with prevention-eligible episodic migraine (EM). All-cause healthcare resource utilization (HCRU) and costs were evaluated at baseline, over the follow-up period and pre/post progression from prevention-eligible EM to chronic migraine. Cox proportional hazards models were used to evaluate risk factors associated with progression. RESULTS, LIMITATIONS, AND CONCLUSIONS: Of the 125,436 patients with prevention-eligible EM that were initially identified, 5,790 (4.6%) were further identified as progressed. Patients who progressed had higher healthcare costs and higher medication use at baseline compared to patients that did not progress. Mean (SD) all-cause total costs per patient per month were $1,790 ($3,788), significantly higher in the post-progression period compared to $1,414 ($2,456) in the pre-progression period in patients who progressed (p < .0001). Younger age, female sex, initial diagnosis by a neurologist, chronic pain, and use of triptans and/or non-specific acute medications were all significant progression risk factors. Results are limited by the use of a heterogeneous population (incident, prevalent, treated, and untreated patients), coding biases, and lack of information on non-prescription drug utilization and plan limits. Limitations aside, there are substantial HCRU and cost burden associated with migraine progression. Younger age, female sex, and the use of specific drug classes are likely to increase migraine disease progression risk.

Direct and Indirect Costs Among United States Commercially Insured Employees With Migraine.

OBJECTIVE: The aim of this study was to compare direct, indirect, and societal (direct plus indirect) costs between patients with and without migraine (controls). METHODS: Patients with migraine were identified from MarketScan claims and Health and Productivity Management databases from January 1, 2010, to December 31, 2013, and were propensity score matched (1:1) to controls. RESULTS: Patients with migraine (N = 26,647) were matched to controls, of whom 4323 were matched for work absence and 26,212 for short-term disability eligibility. Mean annualized direct costs ($13,032 vs $3234), indirect costs due to absence ($4104 vs $3531) and short-term disability ($1131 vs $52), and societal costs due to absence ($16,043 vs $6938) and short-term disability ($14,278 vs $3182) were all significantly higher (P < 0.001) for those patients with migraine versus controls, respectively. CONCLUSION: Migraine imposes high direct and indirect economic burden on payers and society due to significantly higher work productivity loss than controls.

Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers.

PROBLEM: Minimizing driver fatigue among commercial motor-vehicle (CMV) drivers is a major safety issue in the United States. This study examines the effects of potentially fatigue-inducing factors inherent in truck driving work and company safety management in explaining: (a) drivers driving while fatigued, (b) the frequency of close calls due to fatigue, and (c) actual crashes among CMV drivers. METHOD: Data for this study are derived from a survey of CMV drivers in 116 trucking firms, with all data being driver-reported. The relative roles of fatigue-inducing factors and safety management practices in explaining variation in fatigue, close calls, and crashes are reported, along with the roles of fatigue in affecting close calls and crashes via hierarchical regression. RESULTS: Findings indicated that fatigue-inducing factors inherent in driving work and safety practices accounted for appreciable variation in driving fatigued (R(2) =.42) and close calls (R(2) =.35), but not crash involvement. Driving while fatigued also accounted for incremental increases in the amount of variation in close calls, after consideration of inherent factors and safety practices. IMPACT ON INDUSTRY: Findings indicate that safety practices (e.g., establishment of a strong safety culture, dispatcher scheduling practices, company assistance with fatiguing behaviors such as loading and unloading) have considerable potential to offset fatigue-inducing factors associated with truck driving work.

Management practices as antecedents of safety culture within the trucking industry: similarities and differences by hierarchical level.

PROBLEM: A homogeneous perception of safety is important for the achievement of a strong safety culture; however, employees may differ in their safety perceptions, depending on their position and/or hierarchical level within the organization. Moreover, there is limited information on the antecedents of safety culture. This study examines how safety training, driver scheduling autonomy, opportunity for safety input, and management commitment to safety influence individuals' perceptions of safety culture. METHOD: Data for this study were drawn from 116 trucking firms, stratified by three safety performance levels. The data were collected from drivers (lowest hierarchical level), dispatchers (medium hierarchical level), and safety directors (highest hierarchical level), regarding their perceptions of their respective corporate safety cultures. Perceptions of safety culture were analyzed through a linear regression using dummy variables to differentiate among the three hierarchical groups. The resulting model allowed for examination of the specific antecedents of safety culture for the three employee groups and the extent to which the hierarchical groups were in agreement with each other. RESULTS: Driver fatigue training, driver opportunity for safety input, and top management commitment to safety were perceived to be integral determinants of safety culture in all three groups. IMPACT ON INDUSTRY: Trucking firms seeking to strengthen employees' perceptions of safety culture might begin by improving these safety management practices while appreciating that they may have a different impact depending on the employee's hierarchical position (e.g., drivers' perceptions of safety culture are more influenced by top management commitment and driver fatigue training). A fourth safety practice examined, driver scheduling autonomy, was not found to be instrumental in shaping safety culture for any of the three hierarchical levels. Consistent with previous research, implementation of stronger safety cultures should result in fewer accidents.

A comparison of job performance and disciplinary records of smokers and nonsmokers.

The authors compared job performance and receipt of disciplinary action among smoking and nonsmoking hotel employees using organizational records and observation. Although smokers and nonsmokers did not differ on 3 measures of discipline, there were significant differences on a guest relations performance dimension and a summated overall job performance measure. Smokers received higher ratings than did nonsmokers. Implications of these findings for the management of smoking behavior in the workplace are discussed.

An evaluation of a perceived overqualification scale across work settings.

The authors extended and evaluated the dimensionality of the L. J. Khan and P. C. Morrow (1991) subjective underemployment scale. They used data from 3 independent samples to assess the measurement properties of the scale. The results of confirmatory factor analyses supported 2 dimensions and indicated that the measurement model parameters partially generalized across samples. Correlational and additional confirmatory factor analytic results rendered empirical support for most of the postulated relationships of the 2 overqualification dimensions with the somatization, job satisfaction, and organizational commitment variables. The findings indicate that the scale of perceived overqualification needs to be further developed and validated in different samples. The implications of the findings for person-job fit are discussed.