Pharmacoeconomic analysis of bronchial asthma prophylaxis in adults and children with allergic rhinitis by means of sublingual allergen-specific immunotherapy

Abstract

BACKGROUND: Allergic rhinitis is the most common chronic allergic disease worldwide, and bronchial asthma (BA) is one of the most severe complications of allergic rhinitis. Clinical studies reported that sublingual allergen-specific immunotherapy can reduce the incidence of bronchial asthma in children and adults. However, allergen-specific immunotherapy is rather expensive and is not reimbursed by the state, which transfers the cost of this therapy to patients. AIMS: To evaluate the cost-effectiveness of allergen-specific immunotherapy in children and adults with allergic rhinitis and/or allergic rhinoconjunctivitis MATERIALS AND METHODS: The study hypothesized based on study results by Devillier P. et al. in 2019, to which the incidence of asthma was 13.7% and 17.0% in the sublingual allergen-specific immunotherapy + symptomatic therapy and the symptomatic therapy group, respectively (odds ratio: 0.776, 95% confidence interval [0.622; 0.968]). Pharmacoeconomic study based on decision tree model. Costs taken into account are the following: allergen-specific immunotherapy, symptomatic therapy, diagnostics, and routine follow-up visits due to bronchial asthma, outpatient bronchial asthma drug therapy, and hospitalization due to bronchial asthma. The modeling horizon was 5 years, including 2 years of allergen-specific immunotherapy therapy and 3 years of follow-up. RESULTS: The cost per patient when using allergen-specific immunotherapy in combination with symptomatic therapy was 166,711.93 rubles, whereas with symptomatic therapy was 101,700.35 rubles. The cost-effectiveness ratio for allergen-specific immunotherapy in combination with symptomatic therapy was 193,177.20 rubles per 1 prevented case of asthma, whereas 122,530.55 rubles for symptomatic therapy for 1 prevented case of bronchial asthma. Thus, the cost of 1 averted bronchial asthma case when using allergen-specific immunotherapy in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. The cost-benefit analysis result revealed that the incremental cost-utility ratio for an additional year of life adjusted for its quality when performing sublingual allergen-specific immunotherapy in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than the calculated willingness to pay threshold (RUB 2,248,898.50). CONCLUSIONS: The comparison results of the cost of 1 added quality adjusted life years and willingness to pay threshold concluded that sublingual allergen-specific immunotherapy in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with allergic rhinitis.