Healthcare Resource Utilization and Use of Biologics in Chronic Spontaneous Urticaria

Biologic therapies have emerged as effective treatments for chronic spontaneous urticaria (CSU), a debilitating skin disease. However, real-world data on their use are limited. This retrospective descriptive study analyzes the time from diagnosis to biologic therapy initiation and the CSU-specific healthcare resource utilization (HCRU) among patients with ≥ 2 urticaria diagnoses or one urticaria and one angioedema diagnosis with no diagnosis of urticarial vasculitis. This study uses data from the Veterans Health Administration from January 2011 through December 2021. We measured time from diagnosis to biologic initiation and CSU-specific HCRU (outpatient visits, inpatient admissions, emergency room visits, and pharmacy claims) in the 12 month pre- and post-index periods. The final cohort included 26 387 Veterans with CSU. In the 12 month post-index period, 23 699 Veterans (89.8%) started treatment, but only 613 Veterans (2.6%) started biologic therapy, with a median initiation time of 337 days. CSU-specific HCRU increased in the post-index period across all categories. 66.8% of Veterans had pharmacy claims pre-index date compared to 89.8% post-index date, and 92.4% of Veterans had outpatient visits pre-index date compared to 96.7% post-index date. The findings suggest that initiation of biologics may be considered sooner in appropriate patients. The increased HCRU observed in the post-index period highlights the burden that CSU places on patients and the healthcare system.