German claims study finds rising bullous pemphigoid prevalence and healthcare burden

Researchers analysed anonymized statutory health insurance claims for 6.8 million insured individuals in Germany from 2010 to 2023. Annual cross-sectional analyses estimated bullous pemphigoid (BP) prevalence and incidence, while a matched incident cohort of 2,004 adults with BP and 9,950 controls was followed for up to two years to assess comorbidity, mortality, healthcare utilization, costs and pharmacologic management. Mortality and costs were adjusted for age, sex, calendar year and comorbidity.

Estimated BP prevalence rose from 0.05 to 0.14 cases per 1,000 people; annual incidence ranged from 34 to 63 cases per million. Patients with BP had a higher mean Elixhauser comorbidity index than controls (5.0 vs 3.8). One-year mortality was 18.8% versus 6.0% (adjusted incidence rate ratio 3.09; 95% CI 2.71–3.52). Patients with BP had more physician contacts and hospital admissions per year (38 vs 22 and 3.3 vs 0.7, respectively). First-year mean healthcare costs were €20,881 versus €5,586, mainly due to inpatient care.

Topical and systemic corticosteroids were prescribed to 75% and 72% of patients, respectively. The claims-based findings describe associations and treatment patterns; they do not establish causes of excess mortality or compare treatment effectiveness. The authors identify a need for steroid-sparing therapies.