Background. The SQ ® house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet ACARIZAX ® , ALK-Abelló A/S, Hørsholm, Denmark) is an allergy immunotherapy tablet for people with allergic respiratory disease. This analysis aims to assess the cost-effectiveness of the SQ HDM SLIT-tablet from the perspective of three Eastern European countries: Czech Republic, Poland and Slovakia. Methods. A cost-utility model per country was developed, which compared the SQ HDM SLIT-tablet as add-on to pharmacotherapy with pharmacotherapy alone in patients with HDM allergic asthma (AA) over a five year time horizon. The effectiveness of the two interventions was based on the results from a large-scale randomised controlled trial. In the models, annual costs and quality-adjusted life year (QALY) scores from the trial were extrapolated over a five year period, and the incremental cost-effectiveness ratios (ICERs) were estimated. One-way deterministic sensitivity and scenario analyses were undertaken. Results. The SQ HDM SLIT-tablet is cost-effective in all three markets over the five year time horizon (ICERs of less than € 10,000 per additional QALY). Treatment with the SQ HDM SLIT-tablet improves patient outcomes, with QALY gains of 0.35, versus pharmacotherapy only. In all three countries, the SQ HDM SLIT-tablet also incurs increased costs compared to pharmacotherapy treatment only. The sensitivity analysis identified utility values from the clinical trial as the main driver of the model results. Conclusion. The SQ HDM SLIT-tablet is a cost-effective treatment option for people with HDM AA in three different health care settings in Eastern Europe.
A471 the literature was undertaken to identify published resources relating to the unique characteristics of adoptive immunotherapies and the challenges that these technologies may pose for health economic evaluations. Results: The key challenge identified is the high manufacture cost as the therapy is tailored to each patient and, therefore, mass production is not possible. Therefore, to be reimbursed within the UK these therapies would have to produce large QALY gains under the current NICE threshold. These therapies do have the potential to generate significant benefits if they prove to be curative. However, this leads to a second challenge as they are often evaluated in small-scale, single-arm clinical trials. Therefore, to estimate long-term benefits, extrapolation would be required leading to potential uncertainty, which will impact on decisions relating to HTAs. If large QALY gains cannot be established with confidence then it may be necessary to explore alternative payment methods (e.g. lifetime leasing). ConClusions: Adoptive immunotherapies have the potential to generate significant benefits to patients but the high costs of production and uncertainty over long-term outcomes may prove challenging for future HTAs.
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