Reinhold Thomas, Brüggenjürgen Bernd
Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117 Berlin, Germany.
Institute for Health Economy, Steinbeis University Berlin, Berlin, Germany.
Allergo J Int. 2017;26(1):7-15. doi: 10.1007/s40629-016-0002-y. Epub 2016 Nov 21.
Whereas specific immunotherapy (SIT) has already been shown to be cost-effective in the treatment of allergic rhinitis compared with symptomatic treatment, only a small number of investigations have compared sublingual (SLIT) and subcutaneous (SCIT) immunotherapeutic approaches. This analysis discusses the cost-effectiveness of SCIT compared with SLIT and a symptomatic treatment modality. At the same time, particular attention is paid to preparation-specific characteristics.
The investigation is based on a previously published health economic model calculation. A Markov model, with predefined disease stages and a time period of 9 years, formed the basis of the analysis. The data on specific SCIT (Allergovit®) and SLIT (Oralair®) preparations required for the calculation were adjusted for the present analysis. Quality-adjusted life years (QALYs) based on symptom scores were calculated as the endpoint for effectiveness. Furthermore, the total costs and cost effectiveness of SCIT were determined. Model uncertainties were estimated by means of additional sensitivity analyses.
With regard to effectiveness, both the SCIT and SLIT preparations proved superior compared to symptomatic treatment. Although more expensive, SIT seem to be cost-effective. A direct comparison of SCIT (Allergovit®) and SLIT (Oralair®) showed lower total costs for SCIT treatment over the study period (SCIT 1159 € versus SLIT 1322 €) and improved effectiveness (SCIT 7.112 QALYs versus SLIT 7.060 QALYs).
SIT represents a cost-effective treatment option for patients with allergic rhinitis compared with symptomatic treatment. The comparison of SCIT (Allergovit®) and SLIT (Oralair®) showed SCIT to be predominant and cost-effective, due in particular to somewhat greater patient compliance and lower drug costs. It also became evident that, as far as possible, product-specific model variables are required for an economic evaluation of SIT treatment.
尽管特异性免疫疗法（SIT）与对症治疗相比，已被证明在过敏性鼻炎治疗中具有成本效益，但仅有少数研究比较了舌下免疫疗法（SLIT）和皮下免疫疗法（SCIT）。本分析讨论了SCIT与SLIT及一种对症治疗方式相比的成本效益。同时，特别关注制剂的特定特征。
本研究基于先前发表的健康经济模型计算。一个具有预定义疾病阶段和9年时间周期的马尔可夫模型构成了分析的基础。计算所需的特定SCIT（Allergovit®）和SLIT（Oralair®）制剂的数据针对当前分析进行了调整。以症状评分计算的质量调整生命年（QALYs）作为有效性终点。此外，确定了SCIT的总成本和成本效益。通过额外的敏感性分析估计模型的不确定性。
在有效性方面，SCIT和SLIT制剂均被证明优于对症治疗。尽管SIT成本更高，但似乎具有成本效益。SCIT（Allergovit®）和SLIT（Oralair®）的直接比较显示，在研究期间SCIT治疗的总成本更低（SCIT为1159欧元，SLIT为1322欧元），且有效性更高（SCIT为7.112个QALYs，SLIT为7.060个QALYs）。
与对症治疗相比，SIT是过敏性鼻炎患者具有成本效益的治疗选择。SCIT（Allergovit®）和SLIT（Oralair®）的比较显示，SCIT占主导且具有成本效益，这尤其归因于患者依从性稍高和药物成本较低。还很明显，就SIT治疗的经济评估而言，尽可能需要特定产品的模型变量。
