OBJECTIVES: Although chronic spontaneous (idiopathic) urticaria (CSU/CIU) is not life threatening, it can significantly impact a patient’s life when not adequately controlled by medication. Patients experience disturbing itch, intermittent pain, lack of sleep, occupational disabilities and social isolation with high impact on health-related quality of life (HRQoL). However, data on the humanistic burden associated with symptomatic persistent CSU/CIU is scarce. Here we present data on utility values from the first international burden of illness study in CSU/CIU. METHODS: ASSURE-CSU is an observational, non-interventional study which included a 1-year retrospective medical record abstraction and a cross-sectional patient-reported outcomes survey. Adult CSU/CIU patients aged >18 years with disease persisting for ≥12 months despite treatment were assessed. Utility values and domain scores from EQ-5D-3L were described for Canada, Germany, UK and the Netherlands. RESULTS: A total of 88, 98, 79 and 99 patients completed the patient survey which included the EQ-5D-3L in Canada, Germany, UK and the Netherlands, respectively. The mean (SD) EQ-5D-3L utility score was 0.71 (0.30) for Canada; 0.71 (0.25) for Germany; 0.72 (0.31) for UK and 0.76 (0.27) for the Netherlands. Among the different dimensions of EQ-5D-3L, pain/discomfort was the most affected with 62.0%, 70.5%, 61.5% and 56.6% of patients reporting moderate to extreme problems, respectively. The second most affected dimension was anxiety/depression for Canada, Germany and UK with 41.8%, 51.6% and 45.6% of patients reporting moderate to extreme problems, respectively. For the Netherlands, usual activities (44.4%) was the second most affected dimension. Impact across all dimensions increased with disease severity and correspondingly utility values decreased. CONCLUSIONS: This is the first real-world study to assess utility values in CSU/CIU using EQ-5D. Utility scores were similar among the countries and ranged from 0.71 to 0.76, suggesting that CSU/CIU have significant impact on the patients’ health status. Pain/discomfort was the most affected dimension across countries.