OBJECTIVES: Alopecia areata (AA) is a skin disease that poses an economic burden on patients and greatly impairs quality of life. Education level and urban/rural settlement types have been documented to affect costs and create and maintain inequalities for patients with AA. To our knowledge, this is the first cost of illness study (CoI), focused on this pathology, that has been carried out in Romania.

METHODS: We based a bottom-up CoI on a cross-sectional web survey distributed on social media that gathered data on health services and out-of-pocket costs (OOPs). We analyzed (OOPs) that were represented by three cost categories: treatment, medical services (direct medical), and associated expenses, such as transportation and/or hotels (direct non-medical). We report these cost categories considering the most recent education level and settlement type for 41 patients with alopecia areata.

RESULTS: Overall, the direct medical cost was of 24 883.6 EUR while the direct nonmedical of 12 059.7 EUR. The total OOPs for rural patients was of 21 728.9 EUR (by 6 514.3 EUR higher than the patients from urban areas), the highest average costs being for associated expenses (430.5 EUR) for patients from the rural areas and for medical services (344.4 EUR) for patients residing in urban areas. The average costs ranged between 52.5 EUR (primary school) and 611.7 EUR (high school) for treatment expenses, between 258.1 EUR (high school) and 504.3 EUR (post high school) for medical services, and between 158. 4 EUR (university) and 731.9 EUR (primary school) for associated expenses.

CONCLUSIONS: The CoI showed differences across education levels and settlement types. Additional inquiries are needed to establish whether expenses for certain subcategory of treatments, medical services, and associated costs are more prevalent in some groups (in terms of education and settlement types).