Introduction & Objectives: Chronic spontaneous urticaria (CSU) is a common debilitating problem worldwide. Despite its prevalence in the Middle East, very little data is available on the economic impact of CSU on the public health system. This study evaluates the direct medical costs of treating refractory CSU patients in Kuwait. It also evaluates the budget impact of omalizumab (monoclonal anti-IgE antibody) use in these patients.
Methods: Prevalence of CSU was estimated through the Delphi method. Data regarding drug utilization and health care system utilization was collected retrospectively from charts of refractory CSU patients who were followed at the Al-Rashed Allergy center in Kuwait. Costs were calculated from a health system perspective. One-way sensitivity analyses were conducted on the price and utilization of each cost component.
Results: Before omalizumab use, the total direct costs of treating 1,293 refractory CSU patients was estimated to be 1,072,837 KD (US$ 3,570,185) per year, corresponding to around 829.7 KD per patient per annum (US$ 2,761). The total cost was principally generated by outpatient visits 1,072,837 KD; which corresponds to 82.45% of the total cost). After omalizumab use, the cost was estimated to be 4,654,800 KD (US$ 15,490,234) per year, corresponding to around 3,600 KD per patient per annum (US$ 11,980). The total cost was principally generated by omalizumab costs 4,762,895 KD; which corresponds to 97% of the total cost. All other direct costs of treating CSU patients were decreased after the use of omalizumab. Conventional medication costs and hospitalization costs were reduced by 90% and ER costs were reduced by 97%. Cost estimates were most sensitive to variations in the price and utilization of outpatient visits and the price of omalizumab.
Conclusion: The economic burden of refractory CSU in Kuwait is high. The introduction of omalizumab on the health care system is costly because of its high price; however, omalizumab has proven to be effective and is driving all other direct costs down.