The Prevalence of Atopic Dermatitis and Chronic Spontaneous Urticaria are Associated with Parental Socioeconomic Status in Adolescents in China.

The association of atopic dermatitis and chronic spontaneous urticaria with socioeconomic status has been little studied. The aim of this study was to investigate the prevalence of skin diseases and their association with socioeconomic status in adolescents in China. A cross-sectional study was conducted at Central South University, Changsha, China. All newly enrolled students underwent dermatological examination and completed a survey. Socioeconomic status was measured in terms of parental education level and income. Two-level logistic regression models were used. A total of 8,226 students consented to participate. On dermatological examination, moderate to severe acne (10.2%) had the highest prevalence, followed by chronic spontaneous urticaria (2.7%), atopic dermatitis (2.5%), and tinea (1.7%). Socioeconomic status was positively associated with the prevalence of chronic spontaneous urticaria (ptrend = 0.001) and atopic dermatitis (ptrend = 0.0094). Tinea was inversely associated with socioeconomic status (ptrend = 0.025). Higher parental socioeconomic status was associated with higher risk of atopic dermatitis and chronic spontaneous urticaria, but lower risk of tinea.

[Quality of life in chronic urticaria and its relationship with economic impact and disease control in patients attended to at the University Hospital of Monterrey, Mexico]. / Calidad de vida en urticaria crónica y su relación con el impacto económico y control de la enfermedad en pacientes atendidos en el Hospital Universitario de Monterrey, México.

BACKGROUND: Chronic urticaria (CU) manifests itself with hives and sometimes angioedema. Physical and social discomfort worsens patient quality of life. CU has an important impact on patients' economy. OBJECTIVE: To evaluate the relationship of quality of life (QoL) with economic burden and chronic urticaria control of in patients treated at our center. METHODS: Cross-sectional, descriptive, observational study. We included CU-diagnosed adult patients. The CU-Q2oL and UCT questionnaires in Spanish and the economic burden and comorbidities questionnaire developed by our center were applied. A sample size of 36 patients was calculated. RESULTS: 36 patients were included, out of which 58.3% were females. Mean age was 39.9 ± 15.6 years. Regarding QoL, 66.7% of patients reported being "A little" affected, 25% "Somewhat" and 8.3% "A lot", and its relationship with monthly income yielded a p-value of 0.017. 38.9% of patients reported having a monthly income of less than $ 5000 pesos. When disease control was compared with the CU-Q2oL, a significant difference was obtained for questions concerning itching. CONCLUSION: There was association between the quality of life of patients with chronic urticaria and monthly income, the lower the income, the more will the quality of life be affected. Furthermore, greater CU control was observed to reduce the negative effects on quality of life caused by itching.

Antecedentes: La urticaria crónica se manifiesta con erupciones y ocasionalmente con angioedema. La molestia física y social empeora la calidad de vida de los pacientes, quienes, además, enfrentan importantes gastos. Objetivo: Evaluar la relación de la calidad de vida con la carga económica y el control de la urticaria crónica. Métodos: Estudio transversal, descriptivo y observacional. Se incluyeron adultos con diagnóstico de urticaria crónica. Se aplicaron los cuestionarios CU-Q2oL y UCT en español y un cuestionario sobre carga económica y enfermedades coexistentes. Se calculó un tamaño de muestra de 36 pacientes. Resultados: Se incluyeron 36 pacientes, 58.3 % fue del sexo femenino. La edad fue de 39.9 años ± 15.6. Respecto a la calidad de vida, 66.7 % reportó poca afectación, 25 % bastante y 8.3 % mucha; la relación con el ingreso económico mensual obtuvo p = 0.017; 38.9 % refirió ingresos mensuales menores a $5000. Al comparar el control de la enfermedad con el CU-Q2oL se obtuvo diferencia significativa para las preguntas referentes a prurito. Conclusiones: Existió asociación entre calidad de vida de los pacientes con urticaria crónica e ingreso familiar mensual: a menor ingreso, más afectación de la calidad de vida. A mayor control de la enfermedad, menor afectación.

Cost-effectiveness of omalizumab for the treatment of chronic spontaneous urticaria.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a skin disease with itchy hives and/or angio-oedema that last for at least 6 weeks without an obvious external trigger. OBJECTIVES: To determine the cost-effectiveness of omalizumab relative to standard of care (SoC; up to four times the daily dose of H1 -antihistamines) in the Netherlands from a societal perspective. METHODS: The Markov model used consisted of five health states based on Urticaria Activity Score over 7 days. Model settings and characteristics of the Dutch patient population were based on an online survey among clinical experts and were validated during an expert committee meeting. Transition probabilities were derived from the GLACIAL trial. Healthcare consumption, quality of life (using EuroQol-5D) and productivity losses were derived from a burden-of-illness study (ASSURE-CSU) among 93 Dutch patients. Healthcare consumption and productivity losses were evaluated using the Dutch costing manual. The comparator treatment was SoC, consisting of (updosed) antihistamines. A 10-year time horizon was used. RESULTS: The incremental cost-effectiveness ratio (ICER) of omalizumab vs. SoC was €17 502 per quality-adjusted life-year (QALY) gained. Productivity costs played an important role in the value of the ICER; discarding productivity costs resulted in an ICER of €85 310 per QALY. CONCLUSIONS: Omalizumab is cost-effective compared with SoC. The outcomes of this study were used to establish omalizumab as third-line therapy in the Dutch treatment guidelines for CSU.

The burden of chronic spontaneous urticaria: unsatisfactory treatment and healthcare resource utilization in France (the ASSURE-CSU study).

Data on the clinical burden of chronic spontaneous urticaria (CSU) and economic consequences are lacking in France. To characterize the clinical and economic burden of CSU in symptomatic patients despite treatment by analysing data of French patients from the ASSURE-CSU study. ASSURE-CSU was an international observational study that included CSU patients with symptoms that lasted for 12 months or more despite treatment. Disease characteristics and healthcare resource use were obtained from medical records. Data on disease history, health-related quality of life (HR-QoL), and work productivity were collected from a patient survey. A total of 101 patients were analysed (76.2% female; mean age: 48.9 years) with moderate to severe disease (UAS7 score ≥16) in 43.4% and angioedema in 72.3%. The mean (S.D.) total scores of Chronic Urticaria Quality of Life (CU-Q2oL) and Dermatology Life Quality Index (DLQI) were 37.7 (22.3) and 9.7 (6.9), respectively, thus indicating a significant impact of the disease on HR-QoL. Mean absenteeism and presenteeism were 6.4% and 20.8%, respectively, with a mean loss of work productivity estimated at 20.7%. The mean (S.D.) total direct cost of CSU was €2,397 per patient per year and was mainly driven by therapies (€1,435) and inpatient costs (€859). The indirect costs for four weeks were mainly presenteeism (€421) and loss of work productivity (€420). CSU significantly impairs HR-QoL, which increases with the severity of the disease. The direct and indirect costs for the management of symptomatic CSU are an important economic burden.

Direct Medical Costs of Chronic Urticaria in a Private Health Organization of Buenos Aires, Argentina.

BACKGROUND: Scarce studies address the issue of resource consumption and direct health care costs of patients diagnosed with adult-onset chronic urticaria (CU). OBJECTIVES: To estimate medical resource consumption and direct health care costs of affected patients in a private health maintenance organization in Buenos Aires, Argentina. METHODS: Patients diagnosed with adult-onset CU (International Classification of Diseases, Ninth Revision, Clinical Modification code 708.1, 708.8, or 708.9) and who were members of the Italian Hospital Medical Care Program were included in the study. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. Third-quarter 2014 costs were obtained from the Italian Hospital Medical Care Program and converted into US dollars (using the November 2014 exchange rate). RESULTS: A total of 232 patients were included in the study. The mean age at diagnosis was 54.2 ± 20.0 years, and the mean disease duration was 5.4 ± 2.6 years (range, 2-22 years). Of the total number of patients, 75% had allergists as their usual source of care, 23% had dermatologists, 18% had internists, and 3% had rheumatologists. Only 7.8% of the patients had an emergency room admission to manage CU symptoms. To manage the disease, 57.8% of patients used antihistamines and 11.6% used oral corticosteroids. The most relevant source of cost was the medical treatment received, followed by physician visits. The average yearly direct cost per patient was US $1015 ± $752 (95% confidence interval 803-2003). CONCLUSIONS: This is the first Argentine study that evaluated the costs of CU considering the direct medical costs of the disease. The study provides information on resource utilization and the disease-related economic burden, which is valuable to better understand CU in the local setting. Future research that takes into consideration the direct and indirect costs of the disease will expand knowledge and improve management of the disease.

Hives: The target of itching

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Cost Utility of Omalizumab Compared with Standard of Care for the Treatment of Chronic Spontaneous Urticaria.

BACKGROUND: Chronic spontaneous urticaria (CSU) negatively impacts patient quality of life and productivity and is associated with considerable indirect costs to society. OBJECTIVE: The aim of this study was to assess the cost utility of add-on omalizumab treatment compared with standard of care (SOC) in moderate or severe CSU patients with inadequate response to SOC, from the UK societal perspective. METHODS: A Markov model was developed, consisting of health states based on Urticaria Activity Score over 7 days (UAS7) and additional states for relapse, spontaneous remission and death. Model cycle length was 4 weeks, and total model time horizon was 20 years in the base case. The model considered early discontinuation of non-responders (response: UAS7 ≤6) and retreatment upon relapse (relapse: UAS7 ≥16) for responders. Clinical and cost inputs were derived from omalizumab trials and published sources, and cost utility was expressed as incremental cost-effectiveness ratios (ICERs). Scenario analyses included no early discontinuation of non-responders and an altered definition of response (UAS7 <16). RESULTS: With a deterministic ICER of £3183 in the base case, omalizumab was associated with increased costs and benefits relative to SOC. Probabilistic sensitivity analysis supported this result. Productivity inputs were key model drivers, and individual scenarios without early discontinuation of non-responders and adjusted response definitions had little impact on results. ICERs were generally robust to changes in key model parameters and inputs. CONCLUSIONS: In this, the first economic evaluation of omalizumab in CSU from a UK societal perspective, omalizumab consistently represented a treatment option with societal benefit for CSU in the UK across a range of scenarios.

Omalizumab: what benefits should we expect?

Chronic spontaneous urticaria (CSU) is a skin disease characterised by wheal appearance, swelling, itching, and painful skin. Omalizumab has been used for CSU treatment demonstrating good efficacy. To investigate the efficacy and safety of omalizumab treatment in CSU patients in real-life practice. A retrospective analysis was performed on 38 patients suffering from CSU who received 300 mg of omalizumab every four weeks. After omalizumab treatment, 68.4% of patients showed a complete response (UAS7 = 0). All the patients were able to stop treatment with corticosteroids, cyclosporine, and anti-leukotrienes, and only 39.5% of patients remained on anti-histamines. Omalizumab treatment led to a 96% and 65% decrease in emergency room and primary health care visits, respectively, as well as a reduction in the direct costs associated with the disease. No omalizumab-related adverse events were reported. Omalizumab exhibits good efficacy in alleviating the symptoms of CSU, leads to a decrease in concomitant medication use, restores patients' quality of life, and has economic benefits by reducing disease-related health care costs.

Resource use and costs in an insured population of patients with chronic idiopathic/spontaneous urticaria.

BACKGROUND: Chronic idiopathic or spontaneous urticaria (CIU/CSU) impairs patients' quality of life, and updated information on disease prevalence, treatment patterns, and disease burden is lacking. OBJECTIVES: We aimed to estimate these figures in a large US real-world claims database via a validated algorithm. METHODS: In this retrospective cross-sectional cohort study, we identified patients with CIU/CSU, estimated disease prevalence, comorbidities, and healthcare use (medications, office visits, emergency department visits, and hospitalizations) and costs (urticaria related and all cause). RESULTS: We identified 6350 CIU/CSU patients in a population of just over 5.8 million: 0.11 % prevalence. Women accounted for the majority of sufferers (68.3 %) and had a greater burden of illness than men. Patients had relatively few comorbidities (mean 3.3, standard deviation 2.2). Primary care physicians and allergists were the most common providers of CIU/CSU-related care. Oral corticosteroids were the most commonly prescribed medication, used in 54.7 % of patients. Patients accumulated a mean of 15.1 office visits per year (standard deviation 12.6). The mean all-cause healthcare cost totaled over US$9000 per year. CONCLUSIONS: Although the disease affects a relatively young population, CIU/CSU carries a substantial cost. Frequent oral corticosteroid use in CIU/CSU patients is a concern because of adverse events associated with the drug.

Chronic idiopathic urticaria: treatment with omalizumab.

Chronic idiopathic urticaria (CIU) is a common autoimmune skin condition characterized by spontaneously recurring hives for 6 weeks or longer. The new terminology used for CIU in most countries including Canada is chronic spontaneous urticaria (CSU). CSU is associated with significant psychosocial morbidity with a markedly negative impact on overall quality of life. Conventional approaches with antihistamines, even at high doses, is effective in about 50% of patients suffering from CSU. A new treatment option, omalizumab, a humanized monoclonal antibody against the Fc domain of IgE, has undergone the scrutiny of randomized research studies evaluating the efficacy in CSU. This editorial reviews mechanisms of action of omalizumab, efficacy, cost and potential side effect profile. Omalizumab has emerged as a very promising treatment option for patients with CSU. Future research is necessary to establish standardized protocols related to dosing as well as monitoring possible adverse effects of long-term treatment.

Urticaria: impact on quality of life and economic cost.

Patients with urticaria suffer itch, swellings, fatigue caused by sleep disturbance and the side effects of medication, and disruption of many facets of their lives. Much progress has been made in formally evaluating the degree of quality-of-life (QoL) impairment suffered by patients with urticaria. This review focuses on QoL in chronic urticaria (>6 weeks duration) and examines QoL measures, including the chronic urticaria-quality of life questionnaire (CU-Q2oL). Patients with urticaria have difficulty identifying and coping with their emotions. The psychiatric comorbidity and the financial burden on the patient and society because of chronic urticaria, is also examined.

Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria.

BACKGROUND: The literature on chronic idiopathic urticaria (CIU) lacks large-scale population-based studies. OBJECTIVE: To characterize an insured population with CIU, including their demographic characteristics and comorbidities. METHODS: We conducted a cross-sectional analysis using insurance claims. We included patients with 1 outpatient claim with an International Classification of Diseases, 9(th)Edition, Clinical Modification (ICD-9-CM) code for idiopathic, other specified, or unspecified urticaria (ICD-9-CM 708.1, 708.8, or 708.9) and either (1) another of these claims 6 or more weeks later; (2) a claim for angioedema (ICD-9-CM 995.1) 6 or more weeks from the urticaria diagnosis; or (3) overlapping claims for 2 prescription medications commonly used for CIU. RESULTS: We identified 6,019 patients who had claims consistent with CIU. The mean age was 36 years. Fifty-six percent of patients had primary care physicians as their usual source of care, 14% had allergists, and 5% had dermatologists. Allergic rhinitis was diagnosed in 48%, asthma in 21%, other allergy in 19%, and atopic dermatitis in 8%. Sixty-seven percent of patients used prescription antihistamines, 54% used oral corticosteroids (OCSs), 24% used montelukast, and 9% used oral doxepin. Antihistamine users received a mean of 152 days of prescription antihistamines, OCS users 30 days of OCSs, montelukast users 190 days of montelukast, and oral doxepin users 94 days of doxepin. CONCLUSIONS: Primary care physicians managed most patients with CIU. Antihistamines were the most common treatment for CIU, although OCSs were frequently prescribed. Thirty days of OCS supply among users may represent multiple steroid bursts each year. Given the known risks of OCSs, identifying other CIU treatments with more favorable safety profiles may be beneficial.

Cost-intensive, time-consuming, problematical? How physicians in private practice experience the care of urticaria patients.

BACKGROUND: Urticaria is a common and frequently debilitating disease. Nevertheless, there are only few studies examining the situation of urticaria patient care. PATIENTS AND METHODS: In this cross-sectional study, we surveyed dermatologists, pediatricians and general practitioners in the practice setting regarding the epidemiology, situation of care as well as the perception of their patients with chronic spontaneous urticaria. RESULTS: 776 data sets were available. The results show a high frequency of consultations due to chronic spontaneous urticaria. Most of the patients were reported to suffer moderately to severely and to have had history of disease of well over one year. The pediatricians indicated fewer diseases and shorter courses. The majority of participants stated that the time and cost spent on care, as well as the frequency of follow-up visits, are above average. In addition, chronic spontaneous urticaria patients were reported to be a group with a strong emotional burden and high expectations as well as a group that is difficult to satisfy and hard to guide. Only a small minority of physicians rated patient satisfaction with current treatment options and therapy success as high. CONCLUSIONS: Chronic spontaneous urticaria plays an important role in daily practice. Problems are reported on various areas of care. Resolving these problems presents a major challenge and is crucial for improving the quality of patient care.

Annual direct and indirect health care costs of chronic idiopathic urticaria: a cost analysis of 50 nonimmunosuppressed patients.

OBJECTIVE: To estimate annual direct and indirect health care costs in patients with chronic idiopathic urticaria (CIU) managed with conventional therapies. DESIGN: A cost analysis consisting of a survey-guided and retrospective medical record review of direct and indirect health care costs from a societal perspective in patients with CIU. SETTING: The Johns Hopkins University allergy and dermatology ambulatory clinics. PARTICIPANTS: Fifty adults with active CIU were recruited in sequential order. Individuals who were taking corticosteroids or other immunosuppressants in the month before enrollment were excluded from the study. MAIN OUTCOME MEASURES: We estimated direct health care costs, which included laboratory, medication, outpatient visit, and emergency department and hospital visit costs. We also estimated indirect costs, which included earnings lost owing to travel to outpatient visits and absences from work owing to CIU-related illness. RESULTS: Patients with CIU consumed a mean (SD) of $2047 ($1483) annually. Because CIU is primarily an outpatient disease, medication costs alone accounted for 62.5% ($1280) of the total annual cost. Indirect costs accounted for 15.7% ($322) of the total costs. CONCLUSIONS: High medication costs, followed by total indirect costs, result in the largest economic burden among patients with CIU. High medication costs may place low-income patients at risk for suboptimal treatment and increased burden due to poorly controlled disease. Our estimated total health care costs for CIU are comparable to those of other skin diseases such as vitiligo and bullous disease.

[Economic aspects of allergies: status and prospects for Austria]. / Volkswirtschaftliche Aspekte von Allergien. Ausgangslage und Ausblick für Osterreich.

According to epidemiological studies there has been an increase of allergic diseases and corresponding costs. Health economics analyses intend to offer decision guidance towards a more efficient and effective resource distribution, in the conflicting relationship of medicine and economics. In analogy with the "Global Initiative for Asthma (GINA)-study", one arrives at costs of Euro 227.7-455.4 million for the Austrian health system in 2004 for asthma. Direct costs of allergies in general are in part available from health insurance carriers. Between 1998 and 2005 the number of nasal preparations and antiobstructive therapies prescribed rose by 15% and 50% respectively, whilst the costs of these drugs dramatically increased by 96% and 70% respectively. Expenditure on anti-histamines rose by 31% between 2002 and 2004, whereas costs of topical and systemic anti-allergic drugs remained constant. Costs of allergies also include additional costs carried by the individuals affected, which must be added to those covered by the national health insurance carriers. Furthermore, patients with allergies more frequently turn to alternative and complimentary medicine to treat their condition (above all homeopathic remedies, massages and ointments) than people not suffering from allergies. Indirect costs due to allergies are, for instance, those caused by sick leave and loss of productivity. A continual systematic evaluation of available data on allergies in Austria could contribute to more effective implementation of medicines.

Treatment for allergic rhinitis and chronic idiopathic urticaria: focus on oral antihistamines.

OBJECTIVE: To review the efficacy and safety of first- and newer-generation antihistamines for the management of allergic rhinitis and chronic idiopathic urticaria (CIU), with a focus on management in the pharmacy. DATA SOURCES: A literature review was performed using MEDLINE (1966-October 2005), with no time or language restrictions. Key words or phrases used were histamine, antihistamine(s), first- and second-generation, allergic rhinitis, chronic idiopathic urticaria, quality of life, impairment, sedation, cost-effectiveness, astemizole, cetirizine, desloratadine, diphenhydramine, fexofenadine, loratadine, hydroxyzine, ketotifen, and mizolastine. Additional references were found in the bibliographies of the articles cited. STUDY SELECTION AND DATA EXTRACTION: Clinical trials and other experimental studies of the use of antihistamines for the management of allergic rhinitis and CIU were selected. Review papers and guidelines were also included. DATA SYNTHESIS: First-generation antihistamines are effective at ameliorating the symptoms of allergic rhinitis and CIU; however, they are associated with adverse effects due to a lack of selectivity for the histamine H(1)-receptor and an ability to bind to cerebral H(1)-receptors. Newer-generation agents, in general, possess high H(1)-receptor selectivity and a low tendency to cross the blood-brain barrier, while maintaining efficacy. In general, safety at elevated doses has been demonstrated for the newer antihistamines, although higher rates of sedation and impairment have been reported with increasing doses for some agents. CONCLUSIONS: Pharmacists can play an important role in the management of allergic rhinitis and CIU by considering the relative advantages of newer-generation agents when reviewing treatment options.

Chronic idiopathic urticaria treatment.

Chronic idiopathic urticaria (CIU) is a common skin condition that affects 0.1-3 % of people in the USA and Europe and accounts for nearly 75 % of all chronic urticaria cases. Up to 40 % of patients who have chronic urticaria for more than 6 months still have urticarial wheals 10 years later. The therapeutic management should first be oriented towards palliation of symptoms. A 2 % solution of ephedrine as a local spray is very useful for oropharyngeal edema. H1 antihistamines with a low potential for sedation are the most important first-line treatment. Combinations of various antihistamines may be useful in suppressing symptomatology. These include: a) First generation H1 antihistamines; b) Combinations of first and second generations using non-sedating agents in the morning and first generation drugs at night; c) Combinations of second generation antihistamines; d) Combination of doxepin with a first or second generation antihistamine; e) Combination of an H2 anti-receptor antihistamine (eg, cimetidine or ranitidine) with a first or second generation antihistamine. Preliminary reports suggest that desloratadine and anti-leukotrienes may be effective in treating some patients with chronic idiopathic urticaria.

[A questionnaire for patients with chronic urticaria; a diagnostic approach based on structured anamnesis]. / Een vragenlijst voor patiënten met chronische urticaria: gestructureerde anamnese als basis voor diagnostisch beleid.

In only a minority of chronic urticaria patients an underlying cause or illness can be detected. Previous studies demonstrated that detailed history taking is more important than routine laboratory investigations. To improve the process of history taking, the use of a detailed urticaria questionnaire is highly recommended. By using such a history-based diagnostic approach, the costs of laboratory investigations could be reduced from an average of 538 NLG per patient to 84 NLG per patient. The percentage of patients in whom a cause could be found increased from 29% to 53%. No severe underlying illnesses were missed by using this approach.