Impact of increasing treatment rates on cost-effectiveness of subcutaneous immunotherapy (SCIT) in respiratory allergy: a decision analytic modelling approach.

BACKGROUND: Specific immunotherapy is the only causal treatment in respiratory allergy. Due to high treatment cost and possible severe side effects subcutaneous immunotherapy (SCIT) is not indicated in all patients. Nevertheless, reported treatment rates seem to be low. This study aims to analyze the effects of increasing treatment rates of SCIT in respiratory allergy in terms of costs and quality-adjusted life years (QALYs). METHODS: A state-transition Markov model simulates the course of disease of patients with allergic rhinitis, allergic asthma and both diseases over 10 years including a symptom-free state and death. Treatment comprises symptomatic pharmacotherapy alone or combined with SCIT. The model compares two strategies of increased and status quo treatment rates. Transition probabilities are based on routine data. Costs are calculated from the societal perspective applying German unit costs to literature-derived resource consumption. QALYs are determined by translating the mean change in non-preference-based quality of life scores to a change in utility. Key parameters are subjected to deterministic sensitivity analyses. RESULTS: Increasing treatment rates is a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of 3484€/QALY compared to the status quo. The most influential parameters are SCIT discontinuation rates, treatment effects on the transition probabilities and cost of SCIT. Across all parameter variations, the best case leads to dominance of increased treatment rates while the worst case ICER is 34,315€/QALY. Excluding indirect cost leads to a twofold increase in the ICER. CONCLUSIONS: Measures to increase SCIT initiation rates should be implemented and also address improving adherence.

[Societal costs of asthma, COPD and respiratory allergy]. / Maatschappelijke kosten van astma, COPD en respiratoire allergie.

OBJECTIVE: To estimate the societal costs of asthma, COPD and respiratory allergy for the year 2007 and future healthcare costs for the period 2007-2032. DESIGN: Descriptive study. METHODS: Representative registries were used to estimate the healthcare costs of asthma, COPD and respiratory allergy for the year 2007. A simulation model for asthma and COPD and a demographic projection for respiratory allergy were used to determine future healthcare costs. Production losses due to sick leave and work incapacity were calculated using the friction-cost method. RESULTS: Total healthcare costs for asthma, COPD and respiratory allergy in 2007 were estimated at 287, 415 and 103 million euros respectively; on average 530, 1400 and 170 euros per patient with asthma, COPD and respiratory allergy. Average costs of sick leave for asthma were on average 1200 euros and for COPD 1900 euros per employee per year. The costs of work incapacity of an employee with COPD were 1200 euros. There is expected to be an increase in the number of patients from 443,000 in 2007 to 567,000 in 2032 for asthma and from 335,000 to 600,000 for COPD. The number of patients with a respiratory allergy are expected to remain approximately stable at 625,000 patients. The healthcare costs for respiratory allergy are expected to rise by 73%, those for asthma to double, and those for COPD to triple. CONCLUSION: Patients with asthma and COPD have high healthcare costs. Sick leave makes up a large part of the costs of asthma and COPD. In addition, the costs of work incapacity for employees with COPD are high. The number of patients with asthma and COPD will rise in the coming decades, as well as the healthcare costs for these diseases.

The cost-effectiveness of immunotherapy for respiratory allergy: a review.

This article reviews the international literature on the cost-effectiveness of immunotherapy for respiratory allergy. Included studies conducted an economic evaluation of immunotherapy for allergic rhinoconjunctivitis, allergic conjunctivitis, allergic rhinitis, asthma or allergic rhinitis in combination with asthma. Although there were few economic evaluations and these suffered from methodological shortcomings, the evidence appears to support the cost-effectiveness of immunotherapy as compared with pharmacotherapy for allergic rhinoconjunctivitis, subcutaneous immunotherapy as compared with pharmacotherapy for allergic rhinitis and immunotherapy as compared with pharmacotherapy for allergic rhinitis and asthma. One economic evaluation suggested that immunotherapy as compared with pharmacotherapy is unlikely to be cost-effective for asthma. The questions of the cost-effectiveness of sublingual vs subcutaneous immunotherapy and of the cost-effectiveness of immunotherapy for allergic conjunctivitis have not been resolved to date. The cost-effectiveness of immunotherapy depends on the duration of the clinical benefit of immunotherapy following treatment cessation, and on the break-even point of cumulative costs between immunotherapy and pharmacotherapy. There is a need for economic evaluations based on high-quality prospective and long-term clinical studies comparing immunotherapy with pharmacotherapy in real-life practice and comparing sublingual with subcutaneous immunotherapy.

Pharmacoeconomics and immunotherapy.

Pharmacoeconomics is a relatively new discipline whose scope is to describe, measure and compare costs and outcomes of alternative healthcare programmes from a variety of perspectives. This article is aimed at describing the various types of pharmacoeconomics analyses, indicating what types of costs and outcomes could be measured within each type of study, summarising the value of modelling techniques in pharmacoeconomics studies and finally suggesting what kind of pharmacoeconomic research can usefully be conducted in order to appreciate the burden of respiratory allergic disease and to evaluate the economic impact of health technologies that can effectively be used to manage it. Pharmacoeconomics is a relatively recent discipline whose use has been spread by the necessity of decision makers in most industrialised countries, to gain understanding of the economic effect of medical technologies in parallel with their clinical performance: only a wider use of the techniques of pharmacoeconomics analysis, together with an increasing willingness of the scientific community to understand the mechanics and appreciate the added value of pharmacoeconomics analysis, can help the discipline to proceed and provide further improvement to the healthcare system and to the society.

Pharmacoeconomics of subcutaneous allergen immunotherapy.

The current burden of allergic diseases, estimated by both direct and indirect costs, is very relevant. In fact the cost estimation for rhinitis amount globally to 4-10 billion dollars/year in the U.S. and to an average annual cost of 1089 euros per child/adolescent and 1543 euros per adult in Europe. The estimated annual costs in Northern America for asthma amounted to 14 billion dollars. Consequently, preventive strategies aimed at reducing the clinical severity of allergy are potentially able to reduce its costs. Among them, specific immunotherapy (SIT) joins to the preventive capacity the carryover effect once treatment is discontinued. A number of studies, mainly conducted in the US and Germany demonstrated a favourable cost-benefit balance. In the nineties, most surveys on patients with allergic rhinitis and asthma reported significant reductions of the direct and indirect costs in subjects treated with SIT compared to those treated with symptomatic drugs. This is fully confirmed in recent studies conducted in European countries: in Denmark the direct cost per patient/year of the standard care was more than halved following SIT; in Italy a study on Parietaria allergic patients demonstrated a significant difference in favor of SIT plus drug treatment for three years versus drug treatment alone, with a cost reduction starting from the 2nd year and increasing to 48% at the 3rd year, with a highly statistical significance which was maintained up to the 6th year, i.e. 3 years after stopping immunotherapy, corresponding to a net saving for each patient at the final evaluation of 623 euros per year; in France a cost/efficacy analysis comparing SIT and current symptomatic treatment in adults and children with dust mite and pollen allergy showed remarkable savings with SIT for both allergies in adults and children.

Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective.

OBJECTIVE: To evaluate the cost of lost productivity in the workplace due to allergic rhinitis compared to other selected medical conditions from an employer perspective. SETTING AND PARTICIPANTS: A total of 8267 US employees at 47 employer locations who volunteered to participate in health/wellness screenings. MEASUREMENTS: The Work Productivity Short Inventory was used to assess the impact of a predefined group of health conditions on workplace productivity for the previous 12 months. Both absenteeism and presenteeism (lost productivity while at work) were recorded. Costs were calculated using a standard hourly wage. RESULTS: Allergic rhinitis was the most prevalent of the selected conditions; 55% of employees reported experiencing allergic rhinitis symptoms for an average of 52.5 days, were absent 3.6 days per year due to the condition, and were unproductive 2.3 h per workday when experiencing symptoms. The mean total productivity (absenteeism + presenteeism) losses per employee per year were 593 US dollars for allergic rhinitis, 518 US dollars for high stress, 277 US dollars for migraine, 273 US dollars for depression, 269 US dollars for arthritis/rheumatism, 248 US dollars for anxiety disorder, 181 US dollars for respiratory infections, 105 US dollars for hypertension or high blood pressure, 95 US dollars for diabetes, 85 US dollars for asthma, and 40 US dollars for coronary heart disease. The mean total productivity loss per employee per year due to caregiving was 102 US dollars for pediatric respiratory infections, 85 US dollars for pediatric allergies, 49 US dollars for Alzheimer's disease, and 42 US dollars for otitis media/earache. CONCLUSIONS: Allergies are major contributors to the total cost of health-related absenteeism and presenteeism. Payers and employers need to consider this when determining health benefits for employees.

The burden of atopy and asthma in children.

BACKGROUND: There has been a world-wide increase in the prevalence of atopic diseases. These atopic diseases, including asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis, are common in childhood and create a challenge of management for physicians and parents. METHODS: MEDLINE was searched for articles related to atopy, allergy asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis. RESULTS AND CONCLUSIONS: The conditions of asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis cause very significant burdens regarding the discomfort to the affected individual, management problems for the parent and physician and the economic cost to the family and the nation.

["Allergic Progression": importance of Phadiatop and RAST fx5 as screening measures for childhood atopy]. / "La Marche Allergique": interet du Phadiatop et du RAST fx5 comme moyens de depistage de l'atopie chez l'enfant.

Since discovery of IgE in 1967, which was a real revolution in allergy field, new biological methods as Phadiatop for inhalant allergens and RAST fx5 for food allergens, have been used routinely. Both methods are very useful for reliable and cost efficient atopy screening.

Overview of otolaryngic allergy management. An eclectic and cost-effective approach.

Ear, nose, and throat allergic assessment plays an integral role in the evaluation and care of approximately 25% of patients seen in a general otolaryngology practice. With the advances in health care delivery and the influence of managed care organizations, physicians are asked to render cost-effective evaluation and management of their patients. This article examines the economic issues and historical data regarding the work-up of patients with suspected allergic problems. Relative cost-benefits of different modalities of treatments, including avoidance techniques, pharmacotherapy, and immunotherapy, are discussed.