The Impact of Chronic Urticaria from the Patient’s Perspective: A Survey in Five European Countries

Abstract

BackgroundChronic spontaneous urticaria (CSU) is associated with considerable burden, but data from European patients are limited.MethodsThis study is a retrospective, cross-sectional analysis of National Health and Wellness Survey data from the five largest EU countries (5EU: France, Germany, Italy, Spain, and the UK) collected between 2010 and 2013. Burden of disease for patients with CSU was estimated by comparing individuals currently treated for chronic urticaria (proxy CSU cases) with controls selected from respondents without chronic urticaria. Matching and regression models were used to quantify the impact of chronic urticaria on health-related quality of life, self-reported psychological complaints, work and activity impairment, and healthcare use.ResultsThe sample included 175,923 respondents. Prevalence of diagnosed chronic urticaria was 0.5 and 0.2 % were treating the condition with a prescription. Cases (N = 369) had substantially lower (worse) regression-adjusted mean Mental Component Summary (40.2 vs. 45.4), Physical Component Summary (44.6 vs. 49.9), and SF-6D health utility scores (0.63 vs. 0.71; all p < 0.001) relative to controls (N = 1476), differences that exceed accepted minimally important differences for these measures. Depression, anxiety, and sleep difficulties were approximately twice as prevalent among those currently receiving treatment for chronic urticaria (all p < 0.001). Cases also had elevated presenteeism (31 vs. 17 %), overall work impairment (37 vs. 20 %), and impairment in non-work activities (42 vs. 26 %; all p < 0.01) relative to controls. Physician visits (9.1 vs. 4.9), emergency room visits (0.8 vs. 0.3), and hospitalizations (0.3 vs. 0.2) were more frequent than in controls (all p < 0.01).ConclusionsThis research adds to the existing evidence showing significant burden of CSU.Electronic supplementary materialThe online version of this article (doi:10.1007/s40271-015-0145-9) contains supplementary material, which is available to authorized users.

Burden of chronic urticaria relative to psoriasis in five European countries

“…worse) in the CU patients than the overall PsO patients or mild PsO, but similar to the scores reported by moderate/severe PsO patients. These findings are consistent with the results of previous studies which showed that CU patients have a poorer HRQoL in certain dimensions than patients with PsO6, 10, 17 and atopic dermatitis 17. CU patients report worse scores than PsO patients on mood and physical discomfort in a comparative study published by Grob et al 17.…”

“…Patients with CU experience an underestimated emotional and psychological burden which influences sleep and daily activities and restricts work ability and social life 4, 5, 6, 7, 8, 9. HRQoL impairment in CU increases with disease severity,6, 10 prevalence of comorbid psychological conditions11, 12, 13 and several autoimmune conditions 14, 15. Dimensions of HRQoL impairment caused by CU, such as lack of energy, social isolation and emotional disturbances, are comparable with those caused by severe ischaemic heart disease 16.…”

Patient-reported impact of chronic urticaria compared with psoriasis in theUnited States

“…The protocol and questionnaire for the NHWS was approved by Essex Institutional Review Board (Lebanon, NJ). Comparisons of patients with CU treated with prescription medications and matched non-CU controls within the NHWS in the United States and Europe have been previously presented (8,9).…”

“…Furthermore, symptoms last more than five years in up to 14% of patients, which suggests a long-term impact of this disorder (7) In the National Health and Wellness Survey (NHWS), United States and European patients with CU (survey did not evaluate CIU) treated with prescription medications were found to have substantially lower health-related quality of life (HRQL), greater work impairment and a greater prevalence of depression, anxiety and sleep problems when compared with matched controls who never experienced CU (8,9). Data quantifying the mental, physical, and healthcare resource burden of CU, or its most common form, CIU, compared with other dermatological conditions known to impact HRQL are lacking.…”

Looking forward to new targeted treatments for chronic spontaneous urticaria

“…It is a self limiting disorder, persisting for 2–5 years in the majority of cases, although 20% of patients suffer for more than 5 years [2]. Beyond the visual impact of weals and angioedema, quality of life is substantially reduced in patients due to interference with sleep, daily activities, social interaction, work productivity [3] and emotional well-being [4]. There is also a high socioeconomic impact from both the direct (medication and healthcare visits) and indirect costs (absence from or reduced efficiency while at work) [5, 6].…”