COST–BENEFIT ANALYSIS FOR ALLERGEN IMMUNOTHERAPY
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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Address reprint requests to Jonathan A. Bernstein, MD, 231 Bethesda Avenue, ML#563, Cincinnati, OH 45267–0563
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Division of Immunology–Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio