Health economic comparison of SLIT allergen and SCIT allergoid immunotherapy in patients with seasonal grass‐allergic rhinoconjunctivitis in Germany

Abstract

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.

Amelioration of patients with chronic spontaneous urticaria in treatment with vitamin D supplement

“…Some studies have been previously shown levels of IL-10 significantly increased in the sera or cutaneous samples of patients with CSU, compared with the healthy population which is consistent with our data [26]. By contrast, some other studies discovered patients with CSU had lower serum levels of IL-10 compared with the healthy population [27]. …”

Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview

“…Two of these studies are included separately in both asthma and rhinitis analyses. Nineteen studies focussed on allergic rhinitis, three on asthma and one on venom allergy . No studies were identified investigating the cost‐effectiveness of food allergy.…”

“…The overall quality of the studies was low. Of the 19 allergic rhinitis studies, nine were assessed to be of low quality, six medium and four high quality . Of the three asthma studies, two were of a low quality and one high quality .…”

“…Thirteen of the studies were based on randomized controlled trial (RCT) data or meta‐analyses of RCT data including two model‐based evaluations . The remaining studies were based on a mixture of questionnaires, observational data and expert opinion.…”

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

“…[209][210][211][212] Seven studies based on RCT data conducted from a health system perspective and using QALYS as their outcome measure suggests that SLIT and SCIT would be considered cost-effective in this patient population in United Kingdom at the standard National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20 000 (€24 616) per QALY. [213][214][215][216][217][218][219] The studies comparing SCIT and SLIT have given mixed results and do not allow us to conclude whether either treatment is more cost-effective. 220 ICERs for cost evaluations of AIT seem to vary substantially between different health systems suggesting that straightforward conclusions may not be generalizable even across seemingly similar countries.…”