Chronic spontaneous urticaria: costs of over €4,200 per patient and underestimated disability

Chronic Spontaneous Urticaria (CSU) is an autoimmune skin condition with systemic effects, causing severely debilitating symptoms that have a negative impact on patients’ quality of life. Itching, hives on the skin and an unpredictable course of the disease entail not only direct healthcare costs borne by the National Health Service, but also indirect costs that risk being underestimated. The condition usually manifests between the ages of 20 and 40, i.e. in the prime of adulthood and peak productivity, and is twice as common in women as in men. Patients may experience symptoms such as anxiety and depression, which significantly impair aspects of daily life, as well as work and academic performance. In this context, it is therefore a priority to analyse the costs borne both directly by patients and by society as a whole, in order to gain a more comprehensive understanding of the disease’s real social and economic impact. These objectives were the focus of the Italian study recently published in the international scientific journal Global & Regional Health Technology Assessment.

The aim of the study was to estimate the indirect costs and out-of-pocket expenditure incurred by patients with CSU in Italia. The economic model was based on data collected through a survey conducted among patients and carers with the support of the Association for the Research and Treatment of Urticaria (ARCO) and Novartis. The survey was conducted using a questionnaire, distributed via the Association’s social media channels and completed directly by patients and carers. The severity of the disease, classified into three categories—mild, moderate and severe—was based on the respondents’ self-assessment. Indirect costs were estimated using the human capital approach, thereby quantifying the loss of productivity due to the condition through the income of employed patients or carers. Data were analysed for 122 patients; of these, 7% reported mild CSU, 16% moderate and 78% severe. The mean age was 46.8 years, with a mean age at diagnosis of 38.2 years. A diagnostic delay was observed in 63% of cases, with a mean interval of 6.3 years between the onset of the disease and diagnosis. Overall, 50% of employed patients lost working days due to CSU and 63.3% reported a reduction in work productivity (presenteeism); 45.1% of patients received support from a carer, with 37.9% of employed carers reporting lost working days. The economic model estimated an average annual indirect cost per patient with CSU of €4,281, mainly due to presenteeism (59%). Indirect costs increase with the severity of the disease. The average annual out-of-pocket expenditure was €502.7 per patient, 63% of which was attributable to private consultations.

The findings highlight how CSU entails a significant social burden, which is often ‘invisible’ as it is linked primarily to lost productivity and the costs borne directly by patients. This evidence can provide a useful contribution towards a better understanding of CSU and help drive progress towards improved management of this chronic condition, for the benefit of patients and their families. Reducing the impact of the disease on patients’ quality of life and daily routines would enable significant action to be taken to address the loss of working days and productivity not only among patients but also among their carers, with consequent benefits for the system as a whole.

*Researcher at CEIS-EEHTA, Faculty of Economics, University of Rome Tor Vergata