University of Southern California, Los Angeles, California, USA.
Allergy Asthma Proc. 2009 Nov-Dec;30(6):634-42. doi: 10.2500/aap.2009.30.3293.
This study evaluates the costs and utilization burden associated with oral, branded second-generation antihistamines (BSGAs) compared with montelukast (MTLK) as first-choice treatment in newly diagnosed allergic rhinitis (AR) patients without asthma. We compared annual medical costs of illness and utilization changes from 1 year before index AR diagnosis to 1 year after for continuously enrolled AR patients initiating therapy with BSGA or MTLK. Multivariate regressions for each outcome variable adjusted for confounders including age, sex, geographic region, Charlson Comorbidity Index, RxRisk Score, 18 comorbidity groups, and payer type. Treatment selection bias was evaluated by propensity score with all covariates plus instrumental variables including physician type and likelihood of prescribing MTLK versus BSGA. Insurance claims data for the years 2003-2007 included AR patients in all regions of the United States. The final sample included 13,703 AR patients taking BSGAs (84%) or MTLK (16%). After confounder adjustment, MTLK patients experienced higher total medical costs ($1,542 versus $989), drug costs ($714 versus $477), AR drug costs ($474 versus $298), and outpatient visit costs ($480 versus $277) than BSGA patients (all values of p < 0.025). MTLK patients experienced higher total visits (0.96), AR outpatient visits (0.71), and comorbidity visits (0.12) than BSGA patients (all values of p < 0.01). MTLK patients were more likely to add additional AR therapy medications (MTLK, 43.2%; BSGA, 31.6%; p < 0.01). New AR patients prescribed MTLK as first-line medication therapy have higher medical costs and resource utilization than those prescribed first-line oral BSGAs. These differences persisted after adjustment for patient fixed effects, available confounders, and treatment propensity scores.
本研究评估了新诊断的过敏性鼻炎（AR）患者中，与孟鲁司特（MTLK）相比，口服第二代品牌抗组胺药（BSGA）作为一线治疗药物的相关成本和使用负担。我们比较了连续入组的 AR 患者在开始接受 BSGA 或 MTLK 治疗的 1 年前后，1 年的疾病医疗成本和使用变化。对于每个结果变量，我们采用多元回归进行分析，对年龄、性别、地理位置、Charlson 合并症指数、RxRisk 评分、18 种合并症组和支付类型等混杂因素进行调整。采用倾向评分和所有协变量以及包括医生类型和开具 MTLK 与 BSGA 处方可能性的工具变量，对治疗选择偏倚进行评估。2003-2007 年的保险索赔数据包括美国所有地区的 AR 患者。最终样本包括 13703 名服用 BSGA（84%）或 MTLK（16%）的 AR 患者。经过混杂因素调整后，与 BSGA 患者相比，MTLK 患者的总医疗费用（$1542 对$989）、药物费用（$714 对$477）、AR 药物费用（$474 对$298）和门诊就诊费用（$480 对$277）更高（所有 p 值均<0.025）。与 BSGA 患者相比，MTLK 患者的就诊总次数（0.96）、AR 门诊就诊次数（0.71）和合并症就诊次数（0.12）更多（所有 p 值均<0.01）。MTLK 患者更有可能添加其他 AR 治疗药物（MTLK，43.2%；BSGA，31.6%；p<0.01）。作为一线药物治疗处方的新 AR 患者的医疗费用和资源利用率高于一线口服 BSGA 患者。在对患者固定效应、可用混杂因素和治疗倾向评分进行调整后，这些差异仍然存在。
