Ann-Kathrin Richter1, Ludger Klimek2, Hans F Merk3, Norbert Mülleneisen4, Harald Renz5, Wolfgang Wehrmann6, Thomas Werfel7, Eckard Hamelmann8, Uwe Siebert9,10,11, Gaby Sroczynski9, Jürgen Wasem12, Janine Biermann-Stallwitz12. 1. Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany. Ann-Kathrin.Richter@medman.uni-due.de. 2. Centre for Rhinology and Allergology, Wiesbaden, Germany. 3. Clinic for Dermatology and Allergology, University Clinic RWTH, Aachen, Germany. 4. Asthma and Allergy Centre, Leverkusen, Germany. 5. Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University, Marburg, Germany. 6. Dermatological Clinic Prof. Wehrmann, Dr. Rödder-Wehrmann and colleagues, Münster, Germany. 7. Division of Immunodermatology and Allergy Research, Dept of Dermatology and Allergy, Hannover Medical School, Hanover, Germany. 8. Children's Center Bethel, Protestant Hospital Bielefeld and Allergy Center Ruhr-University, Bochum, Germany. 9. Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria. 10. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MGH-ITA, Boston, MA, USA. 11. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 12. Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
Abstract
BACKGROUND: Specific immunotherapy is the only causal treatment in respiratory allergy. Due to high treatment cost and possible severe side effects subcutaneous immunotherapy (SCIT) is not indicated in all patients. Nevertheless, reported treatment rates seem to be low. This study aims to analyze the effects of increasing treatment rates of SCIT in respiratory allergy in terms of costs and quality-adjusted life years (QALYs). METHODS: A state-transition Markov model simulates the course of disease of patients with allergic rhinitis, allergic asthma and both diseases over 10 years including a symptom-free state and death. Treatment comprises symptomatic pharmacotherapy alone or combined with SCIT. The model compares two strategies of increased and status quo treatment rates. Transition probabilities are based on routine data. Costs are calculated from the societal perspective applying German unit costs to literature-derived resource consumption. QALYs are determined by translating the mean change in non-preference-based quality of life scores to a change in utility. Key parameters are subjected to deterministic sensitivity analyses. RESULTS: Increasing treatment rates is a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of 3484€/QALY compared to the status quo. The most influential parameters are SCIT discontinuation rates, treatment effects on the transition probabilities and cost of SCIT. Across all parameter variations, the best case leads to dominance of increased treatment rates while the worst case ICER is 34,315€/QALY. Excluding indirect cost leads to a twofold increase in the ICER. CONCLUSIONS: Measures to increase SCIT initiation rates should be implemented and also address improving adherence.
BACKGROUND: Specific immunotherapy is the only causal treatment in respiratory allergy. Due to high treatment cost and possible severe side effects subcutaneous immunotherapy (SCIT) is not indicated in all patients. Nevertheless, reported treatment rates seem to be low. This study aims to analyze the effects of increasing treatment rates of SCIT in respiratory allergy in terms of costs and quality-adjusted life years (QALYs). METHODS: A state-transition Markov model simulates the course of disease of patients with allergic rhinitis, allergic asthma and both diseases over 10 years including a symptom-free state and death. Treatment comprises symptomatic pharmacotherapy alone or combined with SCIT. The model compares two strategies of increased and status quo treatment rates. Transition probabilities are based on routine data. Costs are calculated from the societal perspective applying German unit costs to literature-derived resource consumption. QALYs are determined by translating the mean change in non-preference-based quality of life scores to a change in utility. Key parameters are subjected to deterministic sensitivity analyses. RESULTS: Increasing treatment rates is a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of 3484€/QALY compared to the status quo. The most influential parameters are SCIT discontinuation rates, treatment effects on the transition probabilities and cost of SCIT. Across all parameter variations, the best case leads to dominance of increased treatment rates while the worst case ICER is 34,315€/QALY. Excluding indirect cost leads to a twofold increase in the ICER. CONCLUSIONS: Measures to increase SCIT initiation rates should be implemented and also address improving adherence.
Authors: M A Calderon; R Gerth van Wijk; I Eichler; P M Matricardi; E M Varga; M V Kopp; P Eng; B Niggemann; A Nieto; E Valovirta; P A Eigenmann; G Pajno; A Bufe; S Halken; K Beyer; U Wahn Journal: Pediatr Allergy Immunol Date: 2012-06 Impact factor: 6.377
Authors: Guy W Scadding; Moises A Calderon; Mohamed H Shamji; Aarif O Eifan; Martin Penagos; Florentina Dumitru; Michelle L Sever; Henry T Bahnson; Kaitie Lawson; Kristina M Harris; Audrey G Plough; Joy Laurienzo Panza; Tielin Qin; Noha Lim; Nadia K Tchao; Alkis Togias; Stephen R Durham Journal: JAMA Date: 2017-02-14 Impact factor: 56.272
Authors: D Jarvis; R Newson; J Lotvall; D Hastan; P Tomassen; T Keil; M Gjomarkaj; B Forsberg; M Gunnbjornsdottir; J Minov; G Brozek; S E Dahlen; E Toskala; M L Kowalski; H Olze; P Howarth; U Krämer; J Baelum; C Loureiro; L Kasper; P J Bousquet; J Bousquet; C Bachert; W Fokkens; P Burney Journal: Allergy Date: 2011-11-04 Impact factor: 13.146
Authors: Cheryl S Hankin; Linda Cox; David Lang; Amy Bronstone; Paul Fass; Bryan Leatherman; Zhaohui Wang Journal: Ann Allergy Asthma Immunol Date: 2010-01 Impact factor: 6.347
Authors: Ronald Dahl; Alexander Kapp; Giselda Colombo; Jan G R de Monchy; Sabina Rak; Waltraud Emminger; Bente Riis; Pernille M Grønager; Stephen R Durham Journal: J Allergy Clin Immunol Date: 2007-12-26 Impact factor: 10.793
Authors: Oliver Pfaar; Tobias Ankermann; Matthias Augustin; Petra Bubel; Sebastian Böing; Randolf Brehler; Peter A Eng; Peter J Fischer; Michael Gerstlauer; Eckard Hamelmann; Thilo Jakob; Jörg Kleine-Tebbe; Matthias Volkmar Kopp; Susanne Lau; Norbert Mülleneisen; Christoph Müller; Katja Nemat; Wolfgang Pfützner; Joachim Saloga; Klaus Strömer; Peter Schmid-Grendelmeier; Antje Schuster; Gunter Johannes Sturm; Christian Taube; Zsolt Szépfalusi; Christian Vogelberg; Martin Wagenmann; Wolfgang Wehrmann; Thomas Werfel; Stefan Wöhrl; Margitta Worm; Bettina Wedi; Susanne Kaul; Vera Mahler; Anja Schwalfenberg Journal: Allergol Select Date: 2022-09-06
Authors: Christian Vogelberg; Eckard Hamelmann; Ulrich Wahn; Anne Domdey; Richard F Pollock; Tobias S Grand Journal: Clinicoecon Outcomes Res Date: 2019-11-06