Cost‐effectiveness of grass pollen allergen immunotherapy in adults. Issue 9 (12th March 2020)

• Record Type: Journal Article
• Authors: Di Bona, Danilo; Bilancia, Massimo; Albanesi, Marcello; Caiaffa, Maria Filomena; Macchia, Luigi
• Is Part Of: Allergy. Volume 75:Issue 9(2020)
• Page Start: 2319
• Page End: 2329
• Publication Date: 2020-03-12
• Subjects: costs -- QALY -- SCIT -- SLIT; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.14246
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: Major scientific societies, such as the EAACI or the AAAAI, do not express any suggestion on which form of allergen immunotherapy (AIT) is to be preferred (subcutaneous immunotherapy, SCIT, vs sublingual immunotherapy, SLIT). This choice could depend on their relative pharmacoeconomic value. Objective: To assess the cost‐effectiveness of AIT for grass pollen, administered as SCIT or SLIT. Methods: We created a Markovian Model, to evaluate, in a hypothetical cohort of adult patients suffering from moderate‐to‐severe rhino‐conjunctivitis with or without allergic asthma, the cost‐effectiveness of SLIT (tablets, Grazax ® and Oralair ® ) or SCIT (various currently available products, plus indirect nonmedical costs, such as travel and productivity costs) in addition to pharmacological therapy, assuming a 9‐year horizon to capture AIT long‐term effects. The incremental cost‐effectiveness ratio (ICER) was calculated assuming pharmacological therapy as the reference comparator. Results: In the base case, SCIT was slightly more expensive, but more effective than SLIT, being the most cost‐effective option (ICER for SCIT, €11 418; ICER for SLIT, €15 212). ICERs greater than €120 000 for both SCIT and SLIT were demonstrated in a scenario assuming that low treatment persistence rates, which are common in real‐life, lead to absence of long‐term AIT clinical benefit. Considering indirect nonmedical costs SLIT resulted more cost‐effective than SCIT (ICER for SCIT, €17 318; ICER for SLIT, €15 212). Conclusion: In daily practice, AIT for grass pollens may be a cost‐effective option only in patients with low discontinuation rates. SCIT, which is less affected by this limitation than SLIT, seems the most cost‐effective AIT form. Abstract : Both SCIT and SLIT for grass pollen are more effective, but also more expensive than standard pharmacological treatment. AIT treatment persistence (ie, completion of the minimal recommended duration of 3 years) significantly affects cost‐effectiveness. In daily practice, AIT for grass pollens may be a cost‐effective option only in patients with high treatment persistence rates. Abbreviations: AIT, allergen immunotherapy; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy; ICER, incremental costeffectiveness ratio