Abstract
Background: Current cost-effectiveness evaluations of the house
dust mite (HDM) allergen immunotherapy fail to account for its effect on
the reduction of exacerbations and medications while considering
potential differences across patient populations. We aimed to evaluate
the cost-effectiveness of subcutaneous immunotherapy (SCIT) plus inhaled
corticosteroids (ICS) vs ICS for pediatric and adult patients with
allergic asthma (AA) and AA with Allergic rhinitis (AR) from the health
care system perspective.
Methods: A Markov model with a 3-month cycle length and a
10-year time horizon was developed. A hypothetical cohort of eight years
old patients with controlled (or partially controlled) AA was the base
case population. Health states were: treatment with GINA Step-3, Step-2,
medication-free asthma and all-cause death. Effectiveness was measured
by the reduction in medication doses and exacerbations. Scenario
analyses were conducted considering AR as a comorbid condition and an
18-years old cohort at baseline with or without AR.
Results: In the base case, the SCIT+ICS would avert 847
exacerbations per 1,000 patients treated and generate additional 0.37
quality-adjusted life years (QALYs) and $836 costs per patient
(SCIT+ICS=6.79 QALYs at a cost of $1,438/patient, ICS=6.42 QALYs at a
cost of $601/patient). An incremental cost-effectiveness ratio (ICER)
of $2,238 per QALY that fall below the willingness to pay threshold was
obtained. The SCIT+ICS was also cost-effective among sub-groups of
interest: adults win AA (ICER=$2,227) and AA+AR patients (8-years old
cohort=$1,628, 18-years old cohort=$1,617).
Conclusion: the SCIT+ICS can be cost-effective for pediatric
and adult patients with AA with or without AR
Keywords: allergen immunotherapy, asthma, cost-effectiveness
analysis, economic evaluation
Abbreviations: SCIT (subcutaneous immunotherapy), ED (emergency
department), WTP (willingness to pay), LABAs (long-acting
beta2-agonists), healthcare resource utilization (HCRU), Inhaled
corticosteroids (ICS), Allergic asthma (AA), Allergen immunotherapy
(AIT), allergic rhinitis (AR), quality-adjusted life-years (QALYs),
Global Initiative of Asthma (GINA), Colombian pesos (COP), American
dollar (USD), randomized controlled trial (RCT), Beclomethasone
Dipropionate (BDP), House Dust Mites (HDM), short acting beta agonists
(SABA)