Economic and Humanistic Burden of Chronic Spontaneous Urticaria: A Systematic Literature Review

OBJECTIVES: Chronic spontaneous urticaria (CSU) is a chronic inflammatory disease that causes itchy hives, angioedema, or both that recur for ≥6 weeks. To comprehensively assess the economic and humanistic burden of CSU, we conducted a systematic literature review, examining the impact of CSU on costs, healthcare resource utilisation (HCRU), and health-related quality of life (HRQoL).

METHODS: MEDLINE, Embase, Cochrane library, PsychINFO, EconLit, key conferences, and health technology assessment body websites were searched for randomised controlled trials and observational studies with timeframe up to September 2021.

RESULTS: 27 publications on costs/HCRU and 75 on HRQoL/utilities were identified. Evidence from North America and Europe was highlighted in this abstract. Purchasing power parity dollars (2014 PPP$) were used in several studies to facilitate cost comparison across countries. Estimated annual direct costs ranged from PPP$ 907 (Italy) to PPP$ 2,984 (France) in the EU and were reported to be PPP$ 1,026 in Canada. Total annual healthcare costs in the US ranged from $9,142 to $15,848. Of baseline productivity, overall work impairment percentages ranged from 18.7%–39.7%, and activity impairment ranged from 23.5%–45.5%. Of baseline HCRU, among CSU patients refractory to H1-antihistamines (AH), a wide range reported at least: one hospitalisation (5.3%–30.3%), one ED visit (14.4%–52.6%), one outpatient visit (48.7%–84.1%), and one specialist visit (41.0%–68.6%). Baseline mean Dermatology Life Quality Index scores (scale: 0–30; higher scores indicate greater impairment) among H1-AH refractory CSU patients ranged from 6.9–16.6. In a UK study using the Urticaria Activity Score over 7 days to derive health states, the estimated EQ-5D scores ranged from 0.710 (severe urticaria) to 0.894 (urticaria-free). In another UK study, the mean EQ-5D score at baseline was 0.66.

CONCLUSIONS: Findings suggest that CSU is associated with varying economic and humanistic burden depending on patient populations, study settings, geographies, and interventions administered.