Indonesia-Based Study of the Clinical and Cost-Saving Benefits of Subcutaneous Allergen Immunotherapy for Children with Allergic Rhinitis in Private Practice

Abstract

Background: Until now, the cost of allergy treatment in the insured public health care system and the non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective: To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in a non-insured self-financing private health care system. Methods: A retrospective cohort study conducted from 2015 until 2020 that compared the clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1098 subjects. Results: A decrease in sp-HDM-IgE level (kU/mL) from 20.5 + 8.75 kU/mL to 12.1 + 3.07 kU/mL was observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT, it costs IDR 21,753,062.7 per child, and for non-SCIT, it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT, it costs IDR 17,024,138.8, while with non-SCIT, it costs IDR 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT, it costs IDR 9,550,126.6, while with non-SCIT, it costs IDR 52,073,938.9. Conclusions: In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

Identification of Robust Biomarkers for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With House Dust Mite-Induced Allergic Rhinitis by Multiple Cytokine Profiling

“…AIT can be performed by subcutaneous (SCIT) or sublingual (SLIT), and growing evidences proved that SCIT was better than SLIT in controlling allergic symptoms, improving compliance and reducing rescue medication consumption (13,14). Although SCIT is a suitable treatment for pediatric AR, not all children respond to this therapy, and the efficacy always fluctuates across users (15)(16)(17). Therefore, to identify and validate potentially important laboratory predictors for SCIT response may play a pivotal role on SCIT treatment for pediatric AR patients.…”

Circulating C-X-C Motif Ligand 13 as a Biomarker for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With Chronic Allergic Rhinitis

“…However, increasing evidence showed that SCIT was more effective than SLIT in reducing allergic symptoms, especially in pediatric AR ( 13 – 15 ). Although SCIT is more effective and compliant, this treatment is not successful for every child who has AR, and the outcome fluctuates among the different users ( 9 , 16 ). Besides, the treatment process of SCIT takes over 3 years, but a reliable method or biomarker to predict the treatment response is absent.…”

Exosomes Derived hsa-miR-4669 as a Novel Biomarker for Early Predicting the Response of Subcutaneous Immunotherapy in Pediatric Allergic Rhinitis

“…[12][13][14] However, there still were some patients who did not respond well to SCIT, and AR children were at higher risk of adverse reactions during SCIT. [15][16][17] Therefore, a trustworthy biomarker to predict the clinical efficacy of SCIT was crucial. 18 Although previous publications discovered that IgG4 antibodies, serum periostin, and specific IgE/total-IgE ratio were associated with SCIT responses and contributed to the immune tolerance formation.…”