Marcus Shaker1, John Oppenheimer2, Dana Wallace3, David M Lang4, Todd Rambasek5, Mark Dykewicz6, Matthew Greenhawt7. 1. Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH. Electronic address: Marcus.S.Shaker@hitchcock.org. 2. Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ. 3. Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla. 4. Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio. 5. Division of Allergy and Immunology, Ohio University Heritage College of Osteopathic Medicine, Sandusky, Ohio. 6. Department of Internal Medicine, Section of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, Mo. 7. Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
Abstract
BACKGROUND: Chronic spontaneous urticaria (CSU) affects approximately 1% of the general population. The cost-effectiveness of routine laboratory testing for secondary causes of CSU has not been formally evaluated. OBJECTIVE: To characterize the cost-effectiveness of routine laboratory screening in adults with CSU. METHODS: A Markov model using cohort analysis and microsimulations was created for adult patients aged 20 years, over a 10-year time horizon, randomized to receive screening laboratory testing or a no-testing approach. Laboratory results were derived from a previously published retrospective analysis of adult patients with CSU. Cost-effectiveness was evaluated at a willingness to pay threshold of $100,000/quality-adjusted life-year using the incremental cost-effectiveness ratio (ICER) in patients with untreated CSU, and patients treated with antihistamines, cyclosporine, or omalizumab. RESULTS: Average laboratory costs per simulated patient with CSU were $573 (standard deviation [SD], $41), with only 0.16% (SD, 3.99%) of tests resulting in improved clinical outcomes. Testing costs per laboratory-associated positive outcome were $358,052 (no therapy), $357,576 (antihistamine therapy), $354,115 (cyclosporine), and $262,121 (omalizumab). Screening tests were not cost-effective, with ICERs of $856,905 (no therapy), $855,764 (antihistamine therapy), $847,483 (cyclosporine), and $627,318 (omalizumab). In the omalizumab-treated subgroup, testing could be cost-effective below $220 or if it resulted in a 0.73% rate of CSU resolution. From a simulated US population perspective, nation-wide screening costs could reach $941,750,741 to $1,833,501,483. CONCLUSIONS: In CSU, the likelihood of clinical improvement from laboratory testing is very low, and testing is not cost-effective. These data support recommendations to not routinely perform laboratory testing in patients with CSU with otherwise normal histories and physical evaluations.
BACKGROUND:Chronic spontaneous urticaria (CSU) affects approximately 1% of the general population. The cost-effectiveness of routine laboratory testing for secondary causes of CSU has not been formally evaluated. OBJECTIVE: To characterize the cost-effectiveness of routine laboratory screening in adults with CSU. METHODS: A Markov model using cohort analysis and microsimulations was created for adult patients aged 20 years, over a 10-year time horizon, randomized to receive screening laboratory testing or a no-testing approach. Laboratory results were derived from a previously published retrospective analysis of adult patients with CSU. Cost-effectiveness was evaluated at a willingness to pay threshold of $100,000/quality-adjusted life-year using the incremental cost-effectiveness ratio (ICER) in patients with untreated CSU, and patients treated with antihistamines, cyclosporine, or omalizumab. RESULTS: Average laboratory costs per simulated patient with CSU were $573 (standard deviation [SD], $41), with only 0.16% (SD, 3.99%) of tests resulting in improved clinical outcomes. Testing costs per laboratory-associated positive outcome were $358,052 (no therapy), $357,576 (antihistamine therapy), $354,115 (cyclosporine), and $262,121 (omalizumab). Screening tests were not cost-effective, with ICERs of $856,905 (no therapy), $855,764 (antihistamine therapy), $847,483 (cyclosporine), and $627,318 (omalizumab). In the omalizumab-treated subgroup, testing could be cost-effective below $220 or if it resulted in a 0.73% rate of CSU resolution. From a simulated US population perspective, nation-wide screening costs could reach $941,750,741 to $1,833,501,483. CONCLUSIONS: In CSU, the likelihood of clinical improvement from laboratory testing is very low, and testing is not cost-effective. These data support recommendations to not routinely perform laboratory testing in patients with CSU with otherwise normal histories and physical evaluations.
Authors: Aubri M Waters; Hyun J Park; Andrew L Weskamp; Allyson Mateja; Megan E Kachur; Jonathan J Lyons; Benjamin J Rosen; Nathan A Boggs Journal: J Allergy Clin Immunol Pract Date: 2022-01-12
Authors: Marcus S Shaker; John Oppenheimer; Mitchell Grayson; David Stukus; Nicholas Hartog; Elena W Y Hsieh; Nicholas Rider; Cullen M Dutmer; Timothy K Vander Leek; Harold Kim; Edmond S Chan; Doug Mack; Anne K Ellis; David Lang; Jay Lieberman; David Fleischer; David B K Golden; Dana Wallace; Jay Portnoy; Giselle Mosnaim; Matthew Greenhawt Journal: J Allergy Clin Immunol Pract Date: 2020-03-26