Pharmacoeconomics of sublingual immunotherapy with the 5-grass pollen tablets for seasonal allergic rhinitis

Abstract

Allergic rhinitis has a very high burden regarding both direct and indirect costs. This makes essential in the management of AR to reduce the clinical severity of the disease and thus to lessen its costs. This particularly concerns allergen immunotherapy (AIT), that, based on its immunological action on the causes of allergy, extends its benefit also after discontinuation of the treatment. From the pharmacoeconomic point of view, any treatment must be evaluated according to its cost-effectiveness, that is, the ratio between the cost of the intervention and its effect. A favorable cost-benefit ratio for AIT was defined, starting from the first studies in the 1990s on subcutaneous immunotherapy (SCIT) in AR patients, that highlighted a clear advantage on costs over the treatment with symptomatic drugs. Such outcome was confirmed also for sublingual immunotherapy (SLIT), that has also the advantage on SCIT to be free of the cost of the injections. Here we review the available literature on pharmacoeconomic data for SLIT with the 5-grass pollen tablets.

Cost‐effectiveness of grass pollen allergen immunotherapy in adults

“…The main reason for the differences between the results of ours and other studies is that the other studies did not include all the available studies, but different subgroups of studies, leading to variability in efficacy and QALY estimates. [6][7][8][9][10][11][12][13][14][15] Nonetheless, whatever the best strategy was (SLIT or SCIT), it must be highlighted that the cost-effectiveness estimates of our study and the others are similar in their magnitude. Hence, the same conclusions reached with this study that AIT cost-effectiveness relative to standard treatment is uncertain, applies also to other cost-effectiveness analyses.…”

“…The strength of this analysis resides in the fact that we used data from already published meta‐analyses synthesizing multiple data sources to improve precision of pooled estimates and, most importantly, to increase generalizability. The main reason for the differences between the results of ours and other studies is that the other studies did not include all the available studies, but different subgroups of studies, leading to variability in efficacy and QALY estimates …”

“…[2][3][4][5] Pharmacoeconomic studies, mainly based on the results of RCTs, suggested that both forms of AIT are cost-effective relative to placebo. [6][7][8][9][10][11][12][13][14][15] However, discrepancies between the clinical settings of RCTs and those of real clinical practice make the assumptions of these modeling studies uncertain and limit the validity of their conclusions. 5,16 Furthermore, data on the relative cost-effectiveness of SCIT vs SLIT are scarce, owing to the lack of efficacy studies aiming at head-to-head comparison between SLIT and SCIT.…”

“…A benefit from both SCIT and SLIT compared with placebo has been consistently demonstrated in randomized controlled trials (RCTs), but the extent of this effectiveness in terms of clinical benefit is unclear . Pharmacoeconomic studies, mainly based on the results of RCTs, suggested that both forms of AIT are cost‐effective relative to placebo . However, discrepancies between the clinical settings of RCTs and those of real clinical practice make the assumptions of these modeling studies uncertain and limit the validity of their conclusions .…”

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

“…It is safe, efficacious and cost-beneficial. [7][8][9][10] SCIT was tried for peanut allergy but high rates of adverse events (AE) deterred from further use. 11,12 Instead, other routes of administration (oral, 13 sublingual, 14 epicutaneous 15 and rectal 16 ) have been tried with varying results.…”