BackgroundAllergoids are chemically modified allergen extracts administered to reduce allergenicity and to maintain immunogenicity. Oralair® (the 5-grass tablet) is a sublingual native grass allergen tablet for pre- and co-seasonal treatment. Based on a literature review, meta-analysis, and cost-effectiveness analysis the relative effects and costs of the 5-grass tablet versus a mix of subcutaneous allergoid compounds for grass pollen allergic rhinoconjunctivitis were assessed.MethodsA Markov model with a time horizon of nine years was used to assess the costs and effects of three-year immunotherapy treatment. Relative efficacy expressed as standardized mean differences was estimated using an indirect comparison on symptom scores extracted from available clinical trials. The Rhinitis Symptom Utility Index (RSUI) was applied as a proxy to estimate utility values for symptom scores. Drug acquisition and other medical costs were derived from published sources as well as estimates for resource use, immunotherapy persistence, and occurrence of asthma. The analysis was executed from the German payer’s perspective, which includes payments of the Statutory Health Insurance (SHI) and additional payments by insurants. Comprehensive deterministic and probabilistic sensitivity analyses and different scenarios were performed to test the uncertainty concerning the incremental model outcomes.ResultsThe applied model predicted a cost-utility ratio of the 5-grass tablet versus a market mix of injectable allergoid products of € 12,593 per QALY in the base case analysis. Predicted incremental costs and QALYs were € 458 (95% confidence interval, CI: € 220; € 739) and 0.036 (95% CI: 0.002; 0.078), respectively. Compared to the allergoid mix the probability of the 5-grass tablet being the most cost-effective treatment option was predicted to be 76% at a willingness-to-pay threshold of € 20,000. The results were most sensitive to changes in efficacy estimates, duration of the pollen season, and immunotherapy persistence rates.ConclusionsThis analysis suggests the sublingual native 5-grass tablet to be cost-effective relative to a mix of subcutaneous allergoid compounds. The robustness of these statements has been confirmed in extensive sensitivity and scenario analyses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-015-0045-z) contains supplementary material, which is available to authorized users.

The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.

Compared to other currently licensed treatment options, SMV + PR represents a cost effective treatment option for patients with chronic genotype 1 HCV infection.

SMV/PR is estimated to be the most cost-effective treatment strategy for treatment-naïve HCV genotype 1 patients in Japan.

objeCtives: Approximately 483 patients in Slovakia are living with HIV, with 68 new infections in 2013. Raltegravir (RAL) is reimbursed for HIV-1-infected treatmentnaive (TN) and treatment-experienced (TE) patients in Slovakia. The objective of this analysis was to determine the cost-effectiveness of dolutegravir (DTG) relative to RAL. Methods: This study is based on the Anti-Retroviral Analysis by Monte Carlo Individual Simulation model. A microsimulation approach simulates the outcome of anti-retroviral therapy by following virological suppression and CD4+ cell count throughout patients' lifetime. Each treatment was assigned its specific efficacy, adverse events rates, and cardiovascular risk according to lipid parameters evolution; and costs and quality of life values were allocated by CD4+ cell count categories and attached to specific events. The analysis was performed from payer's perspective in Slovak settings. Results: Over a lifetime, in TN patients the estimated total costs for the DTG strategy compared with the RAL were lower (220,731€ versus 222,079€ ). The savings for DTG are mostly associated to the lower drug acquisition cost. The life expectancy was similar for the DTG and RAL (31.23 years and 30.82 years). This translated into 0.057 QALYs. DTG was dominant treatment strategy in TN patients. In TE patients, the estimated total costs were slightly higher for the DTG strategy compared with the RAL (192,682€ versus 188,059€ ). These additional costs for the DTG are related to patients living longer with DTG over