Health care burden and treatment patterns in commercially insured children with chronic idiopathic/spontaneous urticaria: A real-world study in the United States

Background: Chronic idiopathic urticaria (CIU)/spontaneous urticaria (CSU) is defined by the presence of wheals, angioedema, or both for >= 6 weeks, with or without an identifiable trigger. Real-world health care data among children with CIU/CSU remain scarce. Objectives: To describe treatment patterns, health care resource utilization (HRU), and costs in pediatric patients with CIU/CSU (< 12 years old) and to compare these with pediatric patients without CIU/CSU. Methods: A commercial administrative claims data base (September 2013 to June 2016) was used. The CIU/CSU cohort included pediatric patients with either two or more claims for a diagnosis of urticaria >= 6 weeks apart or one or more claims for a diagnosis of urticaria and one or more claims for a diagnosis of angioedema >= 6 weeks apart (index was defined as the first claim). The control cohort comprised pediatric patients without urticaria or angioedema (index randomly assigned). Patients with <6 months of eligibility before and after the index date were excluded. HRU and costs were compared between the cohorts during the observation period after propensity score matching. Results: A total of 6109 pediatric patients with CIU/CSU were selected, and 6107 were 1: 1 matched with controls. The patients with CIU/CSU who had a mean +/- standard deviation age of 4.58 +/- 3.36 years, and 47.9% were girls. CIU/CSUrelated medication use increased after diagnosis (e. g., baseline versus 6-month follow-up, 2.2 versus 8.0% for nonsedating prescription H1 antihistamines; 7.4 versus 17.4% for oral corticosteroids). Relative to the controls, the patients with CIU/CSU had higher rates of HRU (incidence rate ratios of 1.71, 2.39, and 2.07 for inpatient, emergency department, and outpatient visits, respectively; all p < 0.01), and higher all-cause per patient per year costs (mean cost differences of $ 2090, $ 1606, and $ 483 for total, medical, and pharmacy costs, respectively; all p < 0.01). Conclusion: This study highlighted unmet needs in pediatric patients with CIU/CSU who had increased medication (e.g., oral corticosteroids) and HRU burden after a diagnosis for CIU/CSU, and higher rates of HRU and costs relative to those without CIU/CSU.