Cost‐effectiveness of grass pollen allergen immunotherapy in adults

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.

HealthSWEDE: costs with sublingual immunotherapy—a Swedish questionnaire study

“…It also important to notice that the present calculation of the economic savings with SLIT is made during the treatment period and that according to previous studies the effect of the therapy will remain far beyond this period thereby further increasing the gains to society. On the other hand, a recent study claims that AIT for grass pollens may be a cost-effective option only in patients with low discontinuation rates and that SCIT, which is less affected by this limitation than SLIT, could be the most cost-effective AIT form [ 18 ]. A cost-minimization analysis from Canada indicates that house dust mite SLIT-tablets are a cost-minimizing alternative to HDM SCIT in treating allergic rhinitis when considered from a societal perspective in the Ontario and Quebec provinces [ 19 ].…”

Research HealthSWEDE: Costs With Sublingual Immunotherapy - A Swedish Questionnaire Study

“…It also important to notice that the present calculation of the economic savings with SLIT is made during the treatment period and that according to previous studies the effect of the therapy will remain far beyond this period thereby further increasing the gains to society. On the other hand, a recent study claims that AIT for grass pollens may be a cost-effective option only in patients with low discontinuation rates and that SCIT, which is less affected by this limitation than SLIT, could be the most cost-effective AIT form [17].…”

Intralymphatic Immunotherapy: A 3-year Randomized, Double-blind Study in 72 Patients With Allergic Rhinitis Due to Birch and Grass

“…Declarations 4 The conjunctival challenge tests (CAPT) with timothy were performed according to the EAACI guidelines (23). Due to lack of extract from the company planned CAPT were not performed after the third pollen season 5 The diary had space for description of the adverse events (AEs) since the last visit. 6 Two to ve days after visit 35, telephone contact was made considering symptoms after the allergen injections.…”