COST–BENEFIT ANALYSIS FOR ALLERGEN IMMUNOTHERAPY

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Current medical health care reimbursements in the United States have evolved from a loosely controlled, fee-for-service system into highly regulated, managed care organizations. Physicians, patients, employers, insurance providers, and local and federal government health agencies have developed a heightened awareness of increasing health care costs in this country and of the responsible driving forces. The discipline of pharmacoeconomics is an important means for assessing the cost versus benefit of medical diagnostic procedures and therapeutic interventions. Pharmacoeconomic studies have been conducted for potential new therapeutic agents, educational programs, and diagnostic or screening procedures in almost every medical and surgical subspecialty. The modification of standard health care protocols is influenced by the demonstration that a drug, educational program or diagnostic/screening procedure improves short- and long-term medical outcomes and quality of life in a cost-effective manner. Medical specialty organizations have developed practice parameters that define consensus state-of-the-art approaches to specific clinical disorders. Whenever possible, these guidelines have incorporated pharmacoeconomic data that support current recommendations.

Pharmacoeconomics has already affected the specialty of allergy and clinical immunology. For example, the design of new investigational drug protocols for the treatment of allergic rhinitis and asthma now frequently include quality-of-life questionnaires.23 These protocols also often monitor changes in end-point parameters such as days lost from school and work, which have previously been demonstrated to correlate with the indirect costs associated with specific disease management.24 Another example of the impact of pharmacoeconomics is the development of asthma self-management programs, which are cost-effective in reducing asthma morbidity.27, 45

There are no well-controlled pharmacoeconomic studies assessing the benefits of allergen immunotherapy in the treatment of allergic rhinitis or allergic asthma. An increased amount of direct and indirect information, however, supports the cost-effectiveness of allergen immunotherapy. Allergen immunotherapy should be scrutinized because it is widely prescribed and constitutes a significant percentage of the total health care costs attributed to the treatment of allergic rhinitis and asthma.

Section snippets

PREVALENCE OF ALLERGIC DISEASES

Allergic rhinitis is the most prevalent chronic disease diagnosed in adolescents 18 years or younger.32 Overall, it is the fifth most prevalent chronic disease diagnosed by physicians in the United States.32 One out of every five visits to a pediatrician's office is for an allergic disorder. The National Health Interview Survey distributed by the Centers for Disease Control and Prevention in 1994 indicated that 10% (26 million) of the population in the United States has allergic rhinitis, and

ECONOMIC IMPACT OF ALLERGIC DISEASES

The economic impact of allergic rhinitis is better appreciated when one considers that patients with this disease have a threefold increased risk for developing asthma.1 A significant percentage of the approximately 4.5% of the US population who suffer from asthma (nearly 10 million individuals) experience exacerbations of their symptoms in response to allergic triggers. Collectively, allergic rhinitis and asthma disorders affect approximately 40 million people in the United States or 15% of

EFFICACY OF ALLERGEN IMMUNOTHERAPY

The prevalence of allergic diseases and magnitude of their associated health care costs require that the advantages and disadvantages of the available therapeutic interventions carefully be examined. Allergen immunotherapy is defined as “the repeated administration of specific allergens to patients with IgE-mediated conditions, for the purpose of providing protection against the allergic symptoms and inflammatory reactions associated with natural exposure to these allergens.”34 The initial

PROPER DIAGNOSIS AND PATIENT SELECTION FOR IMMUNOTHERAPY

Demonstration that a specific therapeutic intervention, such as allergen immunotherapy, is effective does not necessarily prove that it offers a distinct pharmacoeconomic advantage. The decision to implement allergen immunotherapy must incorporate other factors. A primary consideration for initiating allergen immunotherapy is an accurate diagnosis of allergic rhinitis or allergic asthma. To ensure that patients selected for this treatment will benefit, a detailed physician-administered history

APPROPRIATE INITIATION OF ALLERGEN IMMUNOTHERAPY

Present guidelines for initiating allergen immunotherapy imply sound decision analysis based on clinical experience and knowledge of immunopathogenic mechanisms of allergic diseases.34 The consensus recommendations by the Joint Task Force on Practice Parameters for initiating allergen immunotherapy are: (1) symptoms and clinical course correlating with evidence of specific IgE antibodies to clinically relevant allergens; (2) symptoms not adequately controlled with avoidance measures and

COST ANALYSIS: MEDICATION VERSUS ALLERGEN IMMUNOTHERAPY

Pharmacologic treatment of allergic rhinitis often includes combined use of a topical intranasal corticosteroid spray (approximately $30 per canister) and an antihistamine–decongestant (approximately $50–$60 for a 1-month supply of nonsedating, antihistamine–decongestant pills), costing approximately $100 per month or $1200 per year and $6000 for 5 years. This treatment does not include the cost of physician office visits, antibiotics for secondary sinus or otitis media infections, and indirect

SUMMARY

Given the preponderance of evidence that demonstrates the effectiveness of allergen immunotherapy, the major question that needs to be addressed is not whether immunotherapy should be implemented in the treatment of allergic rhinitis and allergic asthma but rather at what point during the course of disease should it be initiated. One of the earliest studies indicated that children with allergic rhinitis treated with immunotherapy had significantly reduced chances of later developing asthma.22 A

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  • Cited by (0)

    Address reprint requests to Jonathan A. Bernstein, MD, 231 Bethesda Avenue, ML#563, Cincinnati, OH 45267–0563

    *

    Division of Immunology–Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio

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