Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1-2% of the general population. Although not life threatening, vitiligo may considerably influence patients' health-related quality of life (QoL) and psychological wellbeing. Willingness-to-pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ-5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71.5% women, mean age 44.4 years, mean disease duration 20.3 years) with vitiligo. The mean DLQI was 7.0 (7.5 in women, 5.5 in men) compared with 8.6 in psoriasis. Of the patients with vitiligo, 24.6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34.1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20-29 years. EQ-5D mean score was 83.6 compared with 75.3 in psoriasis. Of the patients with vitiligo, 32.9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle-aged patients (30-60 years). There was a significant correlation between DLQI scores and WTP (chi(2) = 65.43, P < 0.001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0.001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients' compliance and empowerment.