Allergy Immunotherapy: What Is the Evidence for Cost Saving?
Allergy Immunotherapy: What Is the Evidence for Cost Saving?
Four publications compared the outcomes among SLIT, SCIT, and SDT, and one compared the health economic findings of SCIT versus SLIT.
A CEA was performed using a decision-tree model from the societal perspective, comparing SCIT, SLIT, and SDT in French adults and adolescents with HDM and pollen allergy. Adults were assumed to have received AIT for 4 years and adolescents for 3 years. In adults, the incremental cost per asthma case avoided with SCIT versus SDT was €393 for HDM and €1327 for pollen allergy over a 6-year period. In adolescents, the incremental cost per asthma case avoided with SCIT versus SDT was €583 for HDM and €597 for pollen allergy over a 7-year period. The ICER per additional improved patient ranged from €349 (in adolescents with HDM allergy) to €722 (in adults with pollen allergy). The model presents at least two notable limitations. First, the model excludes costs for allergy-related and asthma-related hospitalizations; the authors, therefore, acknowledge that the cost benefits of AIT may be underestimated. Second, and most importantly, model parameters and assumptions are not clearly explicated, and the reader is unable to confirm the authors' conclusions that AIT (whether delivered subcutaneously or sublingually) is a cost-effective treatment option in allergic rhinitis and asthma due to pollen and house dust mite, and that SLIT is an attractive option in pollen-induced allergic rhinitis, particularly in children.
Pokladnikova et al. evaluated the cost-effectiveness of SLIT compared with SCIT and SDT over 3 years from third-party payer and societal perspectives in the Czech Republic. Total direct medical costs after 3 years of AIT were higher in the SCIT compared with the SLIT group (€416 versus €482, P < 0.001). From a societal perspective, SLIT was 32% less expensive than SCIT (€684 versus €1004, P < 0.001).
Westerhout et al. evaluated the cost-effectiveness of 3 years of treatment with Oralair compared with Grazax (SLIT), Alk Depot SQ (SCIT), or SDT for the treatment of grass-pollen-induced allergic rhinitis from the German healthcare system perspective over a time horizon of 9 years. A meta-analysis of randomized controlled trials of the three active treatments was conducted to determine the effectiveness of each treatment compared with placebo for reducing rhinoconjunctivitis symptom scores and improving the number of SFDs during the pollen season. The incremental cost per QALY and SFD gained with Oralair compared to SDT was €14 728 and €28, respectively. Oralair was the dominant strategy compared with Grazax and Alk Depot SQ.
A budget-impact analysis comparing grass SLIT (Grazax; ALK) and SCIT (Alutard; ALK-Abello) from the perspective of the Danish healthcare system found that SLIT was associated with a total cost savings of €3450 per patient (48%) relative to SCIT. This analysis suggests that, if 1500 patients were treated with grass pollen SLIT instead of SCIT, it would be possible to treat approximately 600 more patients per year without increasing the current cost to the healthcare system.
In the most recently published health economic study, investigators conducted a cost-minimization analysis based on a systematic literature review of double-blind, randomized, placebo-controlled trials that compared four treatments from the Canadian healthcare perspective: Oralair (seasonally administered) and Grazax (perennially administered) SLIT tablets and perennially administered and seasonally administered SCIT. There were 20 trials that satisfied the selection criteria. The indirect analysis suggested improved efficacy in terms of allergic rhinitis symptom control with Oralair over SCIT [standardized mean difference (SMD) = -0.21; P = 0.007] and Grazax (SMD = -0.18; P = 0.018). There were no significant differences in the risk of discontinuation because of adverse events among therapies. In the first year of treatment, Oralair was associated with significant cost savings compared with SCIT administered throughout the year ($2471), SCIT administered seasonally ($948), and Grazax administered throughout the year ($1168). It is likely that the seasonal administration of Oralair contributed to the product's favorable cost savings when compared to perennially administered Grazax and SCIT. However, the significant cost benefits reported for Oralair versus seasonally administered SCIT remain noteworthy.
The Health Economics of Sublingual Immunotherapy Tablets Versus Subcutaneous Immunotherapy With or Without Symptomatic Drug Treatment
Four publications compared the outcomes among SLIT, SCIT, and SDT, and one compared the health economic findings of SCIT versus SLIT.
A CEA was performed using a decision-tree model from the societal perspective, comparing SCIT, SLIT, and SDT in French adults and adolescents with HDM and pollen allergy. Adults were assumed to have received AIT for 4 years and adolescents for 3 years. In adults, the incremental cost per asthma case avoided with SCIT versus SDT was €393 for HDM and €1327 for pollen allergy over a 6-year period. In adolescents, the incremental cost per asthma case avoided with SCIT versus SDT was €583 for HDM and €597 for pollen allergy over a 7-year period. The ICER per additional improved patient ranged from €349 (in adolescents with HDM allergy) to €722 (in adults with pollen allergy). The model presents at least two notable limitations. First, the model excludes costs for allergy-related and asthma-related hospitalizations; the authors, therefore, acknowledge that the cost benefits of AIT may be underestimated. Second, and most importantly, model parameters and assumptions are not clearly explicated, and the reader is unable to confirm the authors' conclusions that AIT (whether delivered subcutaneously or sublingually) is a cost-effective treatment option in allergic rhinitis and asthma due to pollen and house dust mite, and that SLIT is an attractive option in pollen-induced allergic rhinitis, particularly in children.
Pokladnikova et al. evaluated the cost-effectiveness of SLIT compared with SCIT and SDT over 3 years from third-party payer and societal perspectives in the Czech Republic. Total direct medical costs after 3 years of AIT were higher in the SCIT compared with the SLIT group (€416 versus €482, P < 0.001). From a societal perspective, SLIT was 32% less expensive than SCIT (€684 versus €1004, P < 0.001).
Westerhout et al. evaluated the cost-effectiveness of 3 years of treatment with Oralair compared with Grazax (SLIT), Alk Depot SQ (SCIT), or SDT for the treatment of grass-pollen-induced allergic rhinitis from the German healthcare system perspective over a time horizon of 9 years. A meta-analysis of randomized controlled trials of the three active treatments was conducted to determine the effectiveness of each treatment compared with placebo for reducing rhinoconjunctivitis symptom scores and improving the number of SFDs during the pollen season. The incremental cost per QALY and SFD gained with Oralair compared to SDT was €14 728 and €28, respectively. Oralair was the dominant strategy compared with Grazax and Alk Depot SQ.
A budget-impact analysis comparing grass SLIT (Grazax; ALK) and SCIT (Alutard; ALK-Abello) from the perspective of the Danish healthcare system found that SLIT was associated with a total cost savings of €3450 per patient (48%) relative to SCIT. This analysis suggests that, if 1500 patients were treated with grass pollen SLIT instead of SCIT, it would be possible to treat approximately 600 more patients per year without increasing the current cost to the healthcare system.
In the most recently published health economic study, investigators conducted a cost-minimization analysis based on a systematic literature review of double-blind, randomized, placebo-controlled trials that compared four treatments from the Canadian healthcare perspective: Oralair (seasonally administered) and Grazax (perennially administered) SLIT tablets and perennially administered and seasonally administered SCIT. There were 20 trials that satisfied the selection criteria. The indirect analysis suggested improved efficacy in terms of allergic rhinitis symptom control with Oralair over SCIT [standardized mean difference (SMD) = -0.21; P = 0.007] and Grazax (SMD = -0.18; P = 0.018). There were no significant differences in the risk of discontinuation because of adverse events among therapies. In the first year of treatment, Oralair was associated with significant cost savings compared with SCIT administered throughout the year ($2471), SCIT administered seasonally ($948), and Grazax administered throughout the year ($1168). It is likely that the seasonal administration of Oralair contributed to the product's favorable cost savings when compared to perennially administered Grazax and SCIT. However, the significant cost benefits reported for Oralair versus seasonally administered SCIT remain noteworthy.