Economic burden and cost drivers of generalized pustular psoriasis: a systematic review

Generalized pustular psoriasis (GPP), as a rare type of life-threatening psoriasis with currently no effective treatment, imposes a huge economic burden on the healthcare systems. This systematic review aimed to summarize studies on the economic burden of GPP and the corresponding key cost drivers. A systematic search was conducted on PubMed, Web of Science, and Scopus for eligible studies published between 1st January 2000 and 31st December 2024. We strictly followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Among the 324 studies identified, ten eligible studies describing the direct and indirect healthcare costs of GPP across five countries were included in this review. This study demonstrated that the average annual cost associated with GPP spans a wide range, with a mean of USD 23,675 (SD:16,691) [range: 7,791 − 49,891]. Based on the pool estimation, the leading cost drivers for GPP were the costs of inpatient admissions and medications. More than half of GPP patients (54.8%) were on topical steroids, 38.8% were on systemic non-biologic agents, and 14.8% were on biologic agents. For biologic agents, the highest usage was observed in the United States, and lowest usage was observed in China. In conclusion, this systematic review highlights the significant economic burden associated with GPP globally, mainly driven by the costs of admissions and medications. The review also demonstrates the challenges in GPP treatment, including the frequent use of systemic corticosteroids and limited access to newer biologic agents.