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The exclusion criteria were pregnancy and patients with CSU who had received omalizumab for [http://www.selleckchem.com/products/RO4929097.html Selleck RO4929097] in Kuwait. Hence, we used the Delphi method20,21 to estimate the prevalence of refractory CSU in Kuwait. A panel of ten allergists was asked three questions: ��What do you think is the prevalence of CU in Kuwait?��; ��What do you think is the prevalence of CSU in Kuwait?��; and ��What do you [http://en.wikipedia.org/wiki/INPP5D INPP5D] think is the prevalence of patients with refractory CSU?�� The average of the responses was taken and presented in the second round. Then, the average of the second round was taken. The obtained figure was used to indicate the local prevalence of refractory CSU. Identification and allocation of costs In Kuwait, the Ministry of Health (MOH) regulates the basic pricing of health services for both the public and the private sectors. The Kuwaiti government offers all medical services and medications for [http://www.selleckchem.com/products/Nutlin-3.html Nutlin-3 mouse] free to citizens and charges minimally for expatriates. Information on the costs of drugs was obtained from the Central Medical Stores in the MOH. The outpatient visit cost was estimated from personal communication with allergists working in the MOH regarding their salaries and their costs of treating a patient with CSU. The cost of ER visits was taken from a study22 conducted in Kuwait on patients with bronchial asthma. We studied the burden on the health care system and not the society as a whole. We tried to estimate, as closely as possible, the real expenditure for the treatment of refractory CSU from the health care perspective. Costs are reported in US dollars (USD) based on 2014 tariffs. No discounting was applicable. Sensitivity analysis A one-way sensitivity analysis was conducted on the prices and utilization of each cost component by varying its value by ��25%. In addition, a break-even price was calculated to determine how much the price of omalizumab would have to be reduced so that treating CSU with omalizumab would have the same cost as treating it without omalizumab. Ethics The Research Ethics Committee at the Faculty of Medicine and the MOH approved the protocol for the study (number 2015/201). All patients provided written informed consent before participating in the study.

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