Lost working hours and indirect costs: illness takes a heavy toll on patients

Chronic Spontaneous Urticaria (CSU) is an autoimmune skin condition with systemic effects, characterised by severely debilitating symptoms that have a negative impact on patients’ quality of life. Itching, hives on the skin and an unpredictable course of the condition result not only in direct healthcare costs borne by the National Health Service, but also in indirect costs that are at risk of being underestimated. The condition usually manifests between the ages of 20 and 40 – that is, in the prime of adulthood and at the peak of productivity – and is twice as common in women as in men. Patients may experience conditions such as anxiety and depression, which significantly impair various 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 true social and economic impact.

These objectives were the focus of an Italian study recently published in the international scientific journal *Global & Regional Health Technology Assessment*. The study aimed 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 of patients and carers, carried out with the support of the Association for Research and Treatment of Urticaria (ARCO) and Novartis. The survey was carried out using a questionnaire, circulated via the Association’s social media channels and completed independently by patients and carers. The severity of the condition, 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 in terms of the income of employed patients or carers.

Data were analysed for 122 patients; of these, 7 per cent had mild CSU, 16 per cent had moderate CSU and 78 per cent had severe CSU. 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 per cent of employed patients lost working days due to CSU and 63.3 per cent reported a reduction in work productivity (presenteeism); 45.1 per cent of patients received support from a carer, with 37.9 per cent 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 per cent). Indirect costs increase with the severity of the condition. The average annual out-of-pocket expenditure was €502.7 per patient, 63% of which was attributable to private consultations.

The results highlight how CSU entails a significant social burden, which is often ‘invisible’ as it is primarily linked to lost productivity and the costs borne directly by patients. This evidence can make a valuable contribution to 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 the impact on productivity, not only for patients but also for their carers, with consequent benefits for the system as a whole.

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