Real world effectiveness and cost consequences of grass pollen SCIT compared with SLIT and symptomatic treatment

Abstract

Purpose Real-world evidence (RWE) with regard to allergen-specific immunotherapy (AIT) adherence is increasingly available. Economic modelling has already shown AIT to be cost-effective in the treatment of allergic rhinitis compared with symptomatic treatment. However, analyzing sublingual (SLIT) and subcutaneous (SCIT) immunotherapeutic approaches based on RWE adherence data are not available for Germany. This analysis outlines the cost-effectiveness of SCIT compared with SLIT as well as a symptomatic treatment modality on the basis of recent RWE adherence data. Methods A Markov model, with predefined disease stages and a time period of 9 years, was adapted for this analysis. A 6-grass subcutaneous allergoid SCIT preparation and a 5-grass pollen SLIT tablet was employed as AIT administrations. Quality-adjusted life years (QALYs) were calculated based on symptom scores and used as the effectiveness variable. Total costs and cost effectiveness of SCIT, SLIT and symptomatic treatment (ST) were calculated. Model uncertainties were estimated by means of additional sensitivity analyses. Applied discount rate was 3%. Results Both SCIT and SLIT preparations proved superior compared to symptomatic treatment with regard to effectiveness. Although more expensive, AIT also proved to be cost-effective. A direct comparison of SCIT (Allergovit®) and SLIT (Oralair®) showed lower total costs for SCIT treatment over the study period of 9 years (SCIT 1779 € versus SLIT 2438 €) and improved effectiveness (SCIT 7.17 QALYs versus SLIT 7.11 QALYs). Conclusion AIT represents a cost-effective treatment option for patients with allergic rhinitis compared with symptomatic treatment. SCIT appeared to be dominant and cost-effective, due in particular to higher patient adherence and lower drug costs.

Real‐world evidence for the long‐term effect of allergen immunotherapy: Current status on database‐derived European studies

“…Cost‐effectiveness studies for AIT are based on efficacy data from RCTs or metanalyses and usually include results for medication adherence from RWD. There are several analyses investigating cost‐effectiveness of grass pollen AIT for different European countries using adherence data from various sources 54,56–58,60,61 . All proved cost‐effectiveness of SCIT and SLIT compared to symptomatic treatment for patients with allergic rhinitis or rhinoconjunctivitis.…”

“…Management of patients suffering from AR results in high financial burden to patients, healthcare providers, and society 53 . Several pharmacoeconomic studies conducted from a health system perspective in Europe and using QALYS as their outcome measure have reported strong evidence that AIT is cost‐effective in the management of AR and asthma compared with symptomatic treatment alone 54–61 . The magnitude of cost‐effectiveness is likely underestimated because most of the studies did not consider long‐term benefits or preventive and prophylactic effects but only costs during the treatment period 60 .…”

Real-world evidence for the long-term effect of allergen immunotherapy: current status on database-derived studies

“…Management of patients suffering from AR results in high financial burden to patients, health-care providers and society (51). Several pharmacoeconomic studies conducted from a health system perspective in Europe and using QALYS as their outcome measure have reported strong evidence that AIT is cost-effective in the management of AR and asthma compared with symptomatic treatment alone (52)(53)(54)(55)(56)(57)(58)(59). The magnitude of cost-effectiveness is likely underestimated because most of the studies did not consider long-term benefits or preventive and prophylactic effects but only costs during the treatment period (60).…”

“…Cost-effectiveness studies for AIT are based on efficacy data from RCTs or metanalyses and usually include results for medication adherence from RWD. There are several analyses investigating cost-effectiveness of grass pollen AIT for different European countries using adherence data from various sources (52,(54)(55)(56)58,59). All proved costeffectiveness of SCIT and SLIT compared to symptomatic treatment for patients with allergic rhinitis or rhinoconjunctivitis.…”

“…All proved costeffectiveness of SCIT and SLIT compared to symptomatic treatment for patients with allergic rhinitis or rhinoconjunctivitis. For AR, the most recent study analyzing the cost-effectiveness of a SCIT allergoid and a SLIT tablet in Germany showed that SCIT and SLIT are cost-effective compared to symptomatic treatment with SCIT appearing dominant due to higher patient adherence and lower drug costs (17,58). This cost-effectiveness study was the first using drug and treatment costs and RWD adherence data for the same preparations in the same country instead of including data of a combination of AIT preparations or data from other countries as a basis (52,(54)(55)(56)59).…”