Economic Burden of Alopecia Areata in the Kingdom of Saudi Arabia from a Societal Perspective: A Cost-of-Illness Analysis.

Background: 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. Objectives: 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. Methods: 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. Results: The average annual per-patient cost was SAR 20 703 for mild to moderate AA and SAR 76 957 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 102 117 to SAR 167 615 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. Discussion: 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. Conclusions: 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.