Influence of subcutaneous specific immunotherapy on drug costs in children sufferingfrom allergic asthma

Abstract

BackgroundSubcutaneous specific immunotherapy (SCIT) is an effective treatment attenuating the progression of allergic asthma. To date, there is a lack of studies investigating the economic consequences of SCIT on health care expenditures.MethodsA health-economic piggy-back analysis of SCIT was conducted based on a RCT that enrolled 65 children and adolescents with allergic asthma. Patients were allocated into two groups: A group receiving SCIT with a high-dose hypoallergenic house dust mite preparation plus asthma medication and a control group receiving only asthma medication. For both groups asthma control was achieved before the start of the SCIT treatment and was maintained during the study. Both, costs and cost-effectiveness of SCIT with the high-dose hypoallergenic house dust mite preparation were investigated based on total medication costs, incremental medication costs and treatment effects (measured as lung function), respectively. A bootstrap analysis was performed to validate the results.ResultsA steady decline in medication costs could be observed in the SCIT group one year after treatment start compared to the control group. This cost trend became statistically significant 3 years after SCIT started. The calculated potential savings in the SCIT group correlated with an improved lung function. The distribution of the bootstrap results revealed that the probability of SCIT having a superior effectiveness compared to the control group is around 90%.ConclusionSCIT with a high-dose hypoallergenic preparation received by children and adolescents suffering from mite induced allergic asthma reduces the allergic medication intake and has cost-saving effects. Additional costs associated with SCIT may be completely compensated by drug cost savings 4 years after end of SCIT. Additionally, SCIT is superior compared to routine care as measured by the lung function that improved in SCIT-treated patients. Trial registration: (EudraCT no. 2004 – 003892 – 35).

Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview

“…Two of these studies are included separately in both asthma and rhinitis analyses. Nineteen studies focussed on allergic rhinitis, three on asthma and one on venom allergy . No studies were identified investigating the cost‐effectiveness of food allergy.…”

“…Of the 19 allergic rhinitis studies, nine were assessed to be of low quality, six medium and four high quality . Of the three asthma studies, two were of a low quality and one high quality . The one included venom allergy study was assessed to be of medium quality .…”

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

“…The superior cost-effectiveness of HDM-based SCIT over pharmacological treatment in patients with allergic rhinitis and asthma was also confirmed in a Chinese study [222]. A piggy-back study involving 65 children and adolescents with allergic asthma sensitized to HDM allergens who received SCIT for 3 years based on a hypoallergenic high-dose preparation concluded that due to the reduction in drug use, a decline in the costs was evident from the first year and the additional costs associated with SCIT were offset by savings in drugs for symptomatic treatment 4 years after the end of SCIT [223]. In patients with grass-pollen and/ or HDM induced allergic rhino-conjunctivitis and/or asthma, SCIT was associated with reduced disease severity, decreased days with allergy symptoms, increased quality of life, and decreased number of sick days; a conservative estimate of the quality-adjusted life years (QALYs) gained by SCIT was equivalent to 0.03 QALYs gained per SCIT treated patient per year [103].…”

Selection of Patients for Sublingual Versus Subcutaneous Immunotherapy

“…They found significant cost saving in both the adults and children receiving SCIT beginning at 3 months after initiation of SCIT and continuing for the 18-month follow-up. In a German study of children and adolescents with allergic asthma to dust mites, it was shown that the children that received SCIT had a reduced need for allergy medication intake and demonstrated a cost-saving effect [97]. In comparing costs of SLIT to SCIT, Pokladnikova et al showed that SLIT represents a less expensive alternative relative to SCIT from both direct and indirect costs.…”