The Economic Burden of Chronic Urticaria in Portugal: A Patient-Reported Cost-of-Illness Study

INTRODUCTION: Chronic urticaria (CU) substantially impairs an individual's quality of life, yet its costs are seldom quantified and no full cost-of-illness analysis has been published for Portugal. We have estimated the annual societal cost associated with CU in Portuguese adults and examined whether quality-of-life impairment is associated with productivity loss. METHODS: This was a cross-sectional, patient-reported study of 147 adults with a physician-established CU diagnosis, recruited through the national patient association in 2021-2022. A bottom-up, prevalence-based design was applied from a societal perspective. Estimates were post-stratified by disease severity to the AWARE study distribution, and both weighted and unweighted estimates are reported. Per-patient costs were the primary outcome, and national aggregates were secondary outcomes. Regression models adjusted for the severity strata used in the weighting related productivity loss to the Dermatology Life Quality Index (DLQI). Costs are expressed in 2022 euros. RESULTS: The weighted mean annual societal cost was estimated at €4687 per patient (unweighted €7014). Presenteeism accounted for 62.4% (€2927) of the total; employed patients lost 64.2 working days/year [95% confidence interval (CI) 40.6-87.8] to reduced productivity at work, against 1.5 days of absence. Direct costs were €1132 per patient (unweighted €2500), of which patients paid 64% out of pocket. Among employed patients, each DLQI point was associated with €270 (95% CI 131-408) of annual productivity loss after adjustment for severity, and the estimate was unchanged when the work-related DLQI item was excluded. National estimates ranged from €202 million to €927 million per year across prevalence scenarios. CONCLUSIONS: In this self-selected sample, the societal cost of CU was dominated by presenteeism, and the most direct costs were borne by patients. Poorer quality of life was associated with greater productivity loss independently of disease severity. Patient-level estimates are more robust than national extrapolations.