Costs and Healthcare Resource Utilization Associated With Chronic Spontaneous Urticaria: A Systematic Literature Review

OBJECTIVES: Chronic spontaneous urticaria (CSU) is a debilitating skin condition characterized by spontaneous occurrence of itchy hives (wheals) and/or angioedema for >6 weeks. A systematic literature review (SLR) was conducted to compile recent evidence on the costs and healthcare resource utilisation (HRU) associated with CSU.

METHODS: The SLR was conducted following the Centre for Reviews and Dissemination’s guidance and standards of health technology assessment (HTA) bodies. Embase, Medline, Cochrane library, NHS Economic Evaluation Database and clinical trial registries were searched from January 2013 to December 2023. Additionally, key conference proceedings and HTA body websites were hand searched.

RESULTS: The review identified 38 unique studies across 76 publications. In Europe, the mean annual total direct cost for CSU varied from PPP$ (Purchasing Power Parity Dollar) 907.1 in Italy to PPP$2,984.2 in France for year 2014, with therapies and hospitalisations as the major cost drivers. The mean indirect cost over four weeks ranged from PPP$544.8 in France to PPP$1,287.4 in Germany, mainly due to work productivity loss. In the USA, the mean annual total healthcare cost associated with CSU varied from US$12,455.0 in year 2012 to US$17,013.0 in year 2020. In Europe, the proportion of patients with healthcare provider (HCP) visits over 1 year varied from 48.0% in Italy to 86.9% in the Netherlands. The proportion of patients with emergency department (ED) visits and hospitalisations varied from 6.0% in the UK to 24.0% in Italy and 1.2% in the UK to 26.7% in France, respectively. In the USA, a large proportion of patients with CSU reported HCP visits (92.0%-97.3%), ED visits (21.0%-60.2%) and hospitalisations (11.0%-55.9%) in the last 6 months. Notably, CSU patients with angioedema reported higher costs and HRU than those without angioedema.

CONCLUSIONS: CSU imposes a substantial economic burden, driven by high HRU and expenses associated with therapies and hospitalisations.