ECONOMIC BURDEN OF CHRONIC SPONTANEOUS URTICARIA IN BULGARIA: A COST-OF-ILLNESS ANALYSIS
Author(s)
Adriana Dacheva, MA, PhD, Georgi Svetoslavov Slavchev, PhD, Anita Hristova, MA, Hristo Krastev, MA, Marta Encheva-Malinova, PhD, Veneta Todorova, PhD, Slaveyko Djambazov, MBA, PhD.
HTA Ltd, Sofia, Bulgaria.
HTA Ltd, Sofia, Bulgaria.
OBJECTIVES: Chronic spontaneous urticaria (CSU) is an inflammatory skin disease causing wheals and/or angioedema, sleep disruption, emotional distress, productivity loss, and healthcare use. This study estimated the economic burden of CSU in Bulgaria and explored the economic value of reimbursing biologic therapy for employed patients with severe disease.
METHODS: A cross-sectional, questionnaire-based cost-of-illness analysis with a 1-year time horizon was conducted from societal and public payer perspectives. Patient-reported resource use and costs were collected through a questionnaire completed by 175 adult CSU patients across Bulgaria, supported by allergists and dermatologists. Direct medical costs included pharmacotherapy, specialist follow-up, hospitalizations, and paid caregiving. One-time diagnostic expenditures were estimated separately, as they occur mainly before diagnosis. Indirect costs were calculated using the human-capital approach, including absenteeism and presenteeism. Population estimates applied 0.5% adult prevalence and 70% diagnosis rate. ROI compared treatment investment with additional lifetime GDP contribution from improved productivity.
RESULTS: Approximately 26,000 adults were estimated to have CSU in Bulgaria, of whom 18,235 were diagnosed. Annual direct medical costs reached €12.18 million, driven by pharmacotherapy and specialist care. Productivity losses amounted to €7.86 million, representing nearly 40% of recurring annual costs. Additional one-time diagnostic expenditures were estimated at €3.22 million. The total burden was €23.26 million when these expenditures were included, while recurring costs were €20.04 million. Access to reimbursed biologic therapy was limited, with about 1% of diagnosed patients receiving it. For 132 employed patients with severe CSU, reimbursement of omalizumab required €421,165 and was projected to generate €1.41 million in lifetime GDP contribution, corresponding to ROI of +236%, or €3.36 returned per €1 invested.
CONCLUSIONS: CSU generates disproportionate burden in Bulgaria despite low prevalence, with productivity losses as a major cost driver. Improved diagnosis, guideline-aligned management, and access to effective treatments may reduce economic burden, improve disease control, and support sustainable care.
METHODS: A cross-sectional, questionnaire-based cost-of-illness analysis with a 1-year time horizon was conducted from societal and public payer perspectives. Patient-reported resource use and costs were collected through a questionnaire completed by 175 adult CSU patients across Bulgaria, supported by allergists and dermatologists. Direct medical costs included pharmacotherapy, specialist follow-up, hospitalizations, and paid caregiving. One-time diagnostic expenditures were estimated separately, as they occur mainly before diagnosis. Indirect costs were calculated using the human-capital approach, including absenteeism and presenteeism. Population estimates applied 0.5% adult prevalence and 70% diagnosis rate. ROI compared treatment investment with additional lifetime GDP contribution from improved productivity.
RESULTS: Approximately 26,000 adults were estimated to have CSU in Bulgaria, of whom 18,235 were diagnosed. Annual direct medical costs reached €12.18 million, driven by pharmacotherapy and specialist care. Productivity losses amounted to €7.86 million, representing nearly 40% of recurring annual costs. Additional one-time diagnostic expenditures were estimated at €3.22 million. The total burden was €23.26 million when these expenditures were included, while recurring costs were €20.04 million. Access to reimbursed biologic therapy was limited, with about 1% of diagnosed patients receiving it. For 132 employed patients with severe CSU, reimbursement of omalizumab required €421,165 and was projected to generate €1.41 million in lifetime GDP contribution, corresponding to ROI of +236%, or €3.36 returned per €1 invested.
CONCLUSIONS: CSU generates disproportionate burden in Bulgaria despite low prevalence, with productivity losses as a major cost driver. Improved diagnosis, guideline-aligned management, and access to effective treatments may reduce economic burden, improve disease control, and support sustainable care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE424
Topic
Economic Evaluation, Epidemiology & Public Health, Patient-Centered Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
Biologics & Biosimilars, No Additional Disease & Conditions/Specialized Treatment Areas, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Sensory System Disorders (Ear, Eye, Dental, Skin)