Economic burden of Generalized Pustular Psoriasis in Malaysia: a multi-centre analysis of indirect costs.

Background: Generalized Pustular Psoriasis (GPP) constitutes a rare yet severe variant of psoriasis, characterised by extensive pustule formation on the skin and imposes a significant economic burden. The study aimed to investigate the indirect costs associated with GPP in Malaysia, encompassing patients' work productivity losses and out-of-pocket expenses. Methods: This primary, multicentre, cross-sectional cost analysis study was conducted among patients diagnosed with GPP attending public hospitals under the Ministry of Health (MOH) in Malaysia. The indirect costs were assessed using the Work Productivity and Activity Impairment (WPAI) tool and standardised data collection form. Data were statistically analysed using descriptive and inferential statistics using IBM SPSS version 28.0. Results: A total of 54 patients with GPP were enrolled in the study, with about one-fourth experiencing flares at the time of the interview. The total annual indirect cost associated with GPP was estimated at MYR 676,081 (MYR 12,520 per patient). The indirect costs of GPP were driven largely by work productivity loss. Both work and activity impairment were significantly higher during GPP flare periods compared to non-flare periods. Additionally, the annual work impairment cost per patient was substantially higher during GPP flare periods, indicating a marked increase in economic burden compared with the non-flare group. Conclusion: The study demonstrates a substantial indirect economic burden of GPP, driven primarily by work productivity loss, particularly during acute flares. These findings highlight the broader socioeconomic impact of GPP beyond direct costs. Strategies to enhance patients' presenteeism, reduce absenteeism, and prevent unemployment are likely to have the greatest impact on reducing societal costs.