Cost‐effectiveness analysis of house dust mite allergen immunotherapy in children with allergic asthma

Abstract

Background:Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are limited but needed to drive clinical and policy-making decisions such as reimbursement of new interventions. In this study, we compared the cost effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) tablets to the standard of care (SOC) treatment in children with house dust mite-driven (HDM) allergic asthma. Methods:We developed a hypothetical Markov model based on the Global Initiative for Asthma (GINA) severity steps to compare the three strategies over a 10-year horizon divided by cycles of 6 months. SOC was used as a reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were used to assess models' uncertainty. Other scenarios were evaluated to strengthen the presentation of results. Results:The ICER for SCIT and SLIT tablets was 1281€ and 7717€, respectively. The cost-effectiveness threshold for Portugal was 18,482.80€; both treatment approaches were below this limit. The major contributors to these results were the AIT effects on reducing moderate and severe exacerbations and asthma controller medication. In the sensitivity analysis, SCIT revealed a higher probability of cost-effectiveness than SLIT. When including allergic rhinitis as comorbidity, ICER values reduced markedly, especially for SCIT intervention.Conclusions: AIT was cost effective in children with HDM-driven allergic asthma, especially when given by the subcutaneous route. The high probability of cost effectiveness, especially for SCIT, may drive future policy decisions and AIT-prescribing habits.AIT adherence greatly influenced the results highlighting the value of implementing strategies to promote adherence rates.

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“…SLIT had a bigger overall influence on the quality of life. 175 Another study found that SCIT, in combination with inhaled corticosteroids (ICS) was more cost-effective than ICS alone in HDM-induced asthma. 176 Interestingly, switching from SCIT to ILIT for bee venom allergy can result in significant cost savings, potentially halving the treatment costs over 5 years.…”

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“…2 AIT can be applied subcutaneously (SCIT) or sublingually (SLIT) and is suitable for children and adults for a variety of allergens, including pollen, cat, dog, house dust mite, and venom. [63][64][65] SCIT and SLIT have been proven to effectively reduce symptoms and medication use and modify disease pathology, leading to a long-term curative effect after stopping treatment. [66][67][68] AIT relies on the modifying effect on innate and adaptive immune responses associated with type 2 inflammation.…”

“…AIT is indicated for patients with AR whose symptoms remain uncontrolled by avoidance and pharmacotherapy 2 . AIT can be applied subcutaneously (SCIT) or sublingually (SLIT) and is suitable for children and adults for a variety of allergens, including pollen, cat, dog, house dust mite, and venom 63–65 . SCIT and SLIT have been proven to effectively reduce symptoms and medication use and modify disease pathology, leading to a long‐term curative effect after stopping treatment 66–68 .…”

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“…Real-world studies have reported that AIT is cost-effective when assessed using quality-adjusted life years as a metric. 7,17…”