Scenario analyses
In a population of patients with 8 years at baseline and AA+AR, the
SCIT+ICS strategy would generate additional 0.41 QALYs (4.1 months) and
$680 costs per patient (Table 2). This yielded an ICER 27.3% lower
compared to the base case scenario suggesting an increased
cost-effectiveness of the intervention in pediatric patients with AA+AR.
Similar gains in QALYs and additional costs were obtained in a cohort of
adult patients with AA compared to the base case population (Table 2).
Considering AR as a comorbid condition in this population resulted in an
ICER 27.4% lower compared to adult patients with AA alone (Figure 2).
This indicates that the SCIT+ICS would also be considered cost-effective
in adult populations with or without AR.
The scenario with ICS+LABA therapy in a cohort of patients with 8 years
at baseline and AA was associated to higher total costs of the evaluated
strategies (Table 3). This yielded an ICER 16.0% lower compared to the
base case scenario with ICS as the controller therapy. Similar results
were projected for adult patients (Figure 2). In a scenario with a
45.8% of patients with AA achieving medication step-down generated by
the SCIT as reported by Zielen et al. (25) and a sustained effect over 3
years after discontinuation as reported by Stelmach et al. (37), the
break-even point (i.e., moment of time in which the total costs of the
SCIT+ICS+LABA therapy would be lower to the costs associated to
ICS+LABA) was estimated to occur at 17.0 and 10.7 years after SCIT
cessation in pediatric and adult patients, respectively. For patients
with AA+AR, this point would be reached at 10.8 and 8.7 years for
pediatric and adult cohorts, respectively.