Inadequate Health Insurance Coverage: A Major Factor in Premature Discontinuation of Subcutaneous Immunotherapy for Allergic Rhinitis

Abstract

We conducted a study of 155 patients with allergic rhinitis who prematurely discontinued subcutaneous allergen immunotherapy to determine the reasons for their discontinuation. Th e most commonly cited factor, which was cited by 62 patients (40.0%), was the issue of cost-specifi cally, inadequate or nonexistent insurance coverage. Studies have shown that subcutaneous allergen immunotherapy is more cost-eff ective than pharmacologic treatment for patients with allergic rhinitis. Th erefore, improved insurance coverage for this treatment of proven effi cacy would not only improve quality of life, it would also be economically benefi cial to the health care system in general.

Non-adherence to subcutaneous allergen immunotherapy: inadequate health insurance coverage is the leading cause

“…In a recent study consisting of 155 patients, cost of therapy was identified as a major obstacle to completing the full duration of subcutaneous immunotherapy. 8 As with any disease management, cost effectiveness of the treatment remains a major concern, especially in recent times when health care dollars are under scrutiny by the government and health insurance companies. Schadlich et al 18 examined this issue during a period of 10 years and determined that subcutaneous immunotherapy was economically advantageous compared with symptomatic treatment.…”

“…Patients are required to stay in the office for 25 to 30 minutes after receiving injection. 8 Before beginning the immunotherapy regimen, patients signed treatment consent and were asked to contact the respective health insurer.…”

“…7,8 This study was undertaken to identify the factors that led to premature cessation of immunotherapy in patients who discontinued subcutaneous allergen immunotherapy before completing the recommended duration.…”

Socioeconomic Status and Childhood Asthma in Urban Minority Youths. The GALA II and SAGE II Studies

“…Several studies suggest inadequate health coverage and subsequent lack of contact with or low quality of health care may lead to undiagnosed asthma, especially among minorities living in urban environments (15)(16)(17). In addition, having health insurance coverage is associated with achieving tobacco cessation (18), reduced rates of low birth weight (19), and increased likelihood of allergy immunotherapy (20), all which have been shown to reduce the risk of asthma (21)(22)(23). Low SES, often measured by educational attainment and household income, is associated with high exposure to secondhand smoke, poor housing quality, and increase exposure to traffic-related air pollution, each of which is an important predictor of asthma (24)(25)(26).…”

Physician's recommendation and explanation is important in the initiation and maintenance of allergen immunotherapy

“…The main factor for discontinuation of AIT was cost, when health insurance is inadequate or does not exist 10,11. About 70% of the patients in this study had personal insurance; for them, the time consumed by the frequent hospital visits and long treatment duration were the main barriers to AIT adherence.…”