Estimativa de custos relacionados a urticária crônica em tratamento ambulatorial especializado

Abstract

Chronic urticária (CU) affects 1% of the population, being more frequente in adults, especially middle-aged women. Despite the low mortality, it has high morbidity, great impact on quality of life and little known economic costs in our country. The aim of this study was to evaluate the costs associated with CU in our country, both the direct cost, related to the use of medical and hospital resources; as the indirect, related to the work and school absenteeism in patients followed in specialized ambulatory. This is a descriptive longitudinal study of patients with chronic spontaneous urticarial (CSU) and or chronic inducible urticarial (CIndU) who attended at least four consultations in a specialized outpatient clinic for 12 months. Those with other skin signs/symptoms and those who discontinued treatment were excluded. The following variables were analyzed: gender, age, type of urticarial, duration of disease and follow-up Urticaria Activity Score (UAS), Chronic Urticaria Quality of Life Questionnaire (CU-QoL), all medications used to treat UC, and data on direct and indirect treatment costs were collected at each visit. Continuous variables with normal distribution were evaluated by Student`s test of ANOVA, with Tukey´s post-hoc test. The results related to the total cost of CU were submitted to multivariate linear regression analysis to assess the impact on family income, education and disease severity on the total cost. From November 2016 to December 2018, 68 patients were included; eleven discontinued treatment and two were discharged and excluded from the study. We evaluated 55 patients, of whom 44 (80%) were female, 43 (78%) adults and 12 (22%) children/adolescents, with a mean age of 40 years (SD ± 20,30), 38 (69%) white and 17 (31%) brown/black. The mean duration of the disease was 66 months (SD ± 37,00) and medical diagnosis time at CU was 24 months (SD ± 13,00) and follow-up time was 18 months (SD ± 12,00). Twenty-four patients (43%) was diagnosed with CSU, 21 (38%) with CSU associated to CIndU and 10 (18%) isolated CIndU. Angioedema was observed in 24 (43%) patients. The average family income was US$ 1,428.09 (US$ 0,00 9,045.22; SD ± 1,571.70). The total cost of outpatient/emergency and non-medical appointments was US$ 3,838.17 (US$ 69.79 pacient-year; SD ± 112.09). The cost of complementary exams was US$ 6,607.39 (US$ 120.13 pacient-year; SD ± 63.81) and the cost of medication was US$ 174,697.58 (US$ 3,176.31 pacient-year; SD ± 6,271.71), of which US$ 141,582.91 was spent on omalizumab in 12 patients (mean US$ 2,574.23 patient-year; SD ± 5,925.58). The cost of transportation was US$ 3,755.69 (US$ 68.28 patient-year; SD ± 77.00). The total cost of absenteeism was US$ 21,125.84 (US$ 384.10 patient-year; SD ± 2,127.01). The total cost of chronic urticária-year was US$ 210,024.67 and the average per patient-year was US$ 3,818.62 patient-year (SD ± 7,101.74). Conclusion: CU has a significant cost for the population studied, with the largest share resulting from direct costs. The cost of medications, especially with the use of omalizumab, result in the greatest economic burden for patients with CU. The higher the education, family income and the severity of the disease, the higher the cost of UC.