University of Southern California Center for the Health Professions, Los Angeles, CA 90033, USA.
Curr Med Res Opin. 2009 Jun;25(6):1421-31. doi: 10.1185/03007990902875992.
To review the pharmacoeconomic literature evaluating use of antihistamines in treating allergic rhinitis (AR) in the US.
Three independent reviewers conducted a comprehensive search of the current literature with PubMed. They identified articles describing original research comprising US cost analyses or pharmacoeconomic evaluations that reported both costs and consequences of using second-generation anthistamines (SGAs), first-generation antihistamines (FGAs), or both for the treatment of patients with AR. The search was limited to studies performed in humans and published in English between 1998 and 2008.
Five of 200 articles met the inclusion criteria and examined costs associated primarily with chlorpheniramine, diphenhydramine, cetirizine, and fexofenadine. The first two studies retrospectively analyzed a claims database and concluded that fexofenadine was associated with slightly lower overall costs than loratadine and cetirizine. A third study compared total healthcare costs associated with FGAs and SGAs, concluding that despite their higher prescription cost, SGAs result in lower medical resource use and lower cost for treatment of AR versus FGAs, although no individual SGA could be distinguished as providing substantial healthcare cost savings or increased cost-effectiveness over the other SGAs. Two studies investigated the impact of transitioning a prescription SGA to over-the-counter status and concluded that such a transition would provide cost savings to healthcare plans, but did not address the cost or health effect of such a switch on specific populations whose plans might no longer cover prescription SGAs.
Preliminary evidence suggests that newer SGAs offer clinical, pharmacodynamic, and pharmacokinetic advantages that may translate into superior cost-effectiveness in the treatment of AR. Further study is warranted to clarify the pharmacoeconomic impact of the newer SGAs and to establish their relative cost-effectiveness.
综述评估抗组胺药治疗变应性鼻炎（AR）的美国药物经济学文献。
3 名独立评审员利用 PubMed 进行全面的文献检索。他们确定了描述原始研究的文章，这些原始研究包括美国成本分析或药物经济学评估，报告了第二代抗组胺药（SGAs）、第一代抗组胺药（FGAs）或两者联合用于治疗 AR 患者的成本和结果。检索仅限于在人类中进行且于 1998 年至 2008 年间用英文发表的研究。
在 200 篇文章中，有 5 篇符合纳入标准，主要考察了与氯苯那敏、苯海拉明、西替利嗪和非索非那定相关的成本。前两项研究回顾性分析了索赔数据库，结论是与氯雷他定和西替利嗪相比，非索非那定的总体成本略低。第三项研究比较了 FGAs 和 SGAs 相关的总医疗保健成本，结论是尽管 SGAs 的处方费用较高，但与 FGAs 相比，SGAs 可降低医疗资源的使用和治疗 AR 的成本，尽管不能确定个别 SGA 相对于其他 SGAs 可节省大量医疗保健成本或提高成本效益。有两项研究调查了将处方 SGA 转换为非处方状态的影响，结论是这种转换将为医疗保健计划节省成本，但未解决特定人群的成本或健康影响，这些人群的计划可能不再涵盖处方 SGAs。
初步证据表明，新型 SGAs 具有临床、药效动力学和药代动力学优势，可能在治疗 AR 方面具有更高的成本效益。需要进一步研究来阐明新型 SGAs 的药物经济学影响，并确定它们的相对成本效益。
