Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
Centre for Rhinology and Allergology, Wiesbaden, Germany.
Eur J Health Econ. 2018 Dec;19(9):1229-1242. doi: 10.1007/s10198-018-0970-6. Epub 2018 Mar 24.
Specific immunotherapy is the only causal treatment in respiratory allergy. Due to high treatment cost and possible severe side effects subcutaneous immunotherapy (SCIT) is not indicated in all patients. Nevertheless, reported treatment rates seem to be low. This study aims to analyze the effects of increasing treatment rates of SCIT in respiratory allergy in terms of costs and quality-adjusted life years (QALYs).
A state-transition Markov model simulates the course of disease of patients with allergic rhinitis, allergic asthma and both diseases over 10 years including a symptom-free state and death. Treatment comprises symptomatic pharmacotherapy alone or combined with SCIT. The model compares two strategies of increased and status quo treatment rates. Transition probabilities are based on routine data. Costs are calculated from the societal perspective applying German unit costs to literature-derived resource consumption. QALYs are determined by translating the mean change in non-preference-based quality of life scores to a change in utility. Key parameters are subjected to deterministic sensitivity analyses.
Increasing treatment rates is a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of 3484€/QALY compared to the status quo. The most influential parameters are SCIT discontinuation rates, treatment effects on the transition probabilities and cost of SCIT. Across all parameter variations, the best case leads to dominance of increased treatment rates while the worst case ICER is 34,315€/QALY. Excluding indirect cost leads to a twofold increase in the ICER.
Measures to increase SCIT initiation rates should be implemented and also address improving adherence.
特异性免疫疗法是呼吸道过敏的唯一因果疗法。由于治疗费用高，且可能出现严重副作用，皮下免疫疗法（SCIT）并非所有患者都适用。然而，报告的治疗率似乎很低。本研究旨在分析提高呼吸道过敏 SCIT 治疗率对成本和质量调整生命年（QALYs）的影响。
状态转移马尔可夫模型模拟了 10 年中过敏性鼻炎、过敏性哮喘和两种疾病患者的疾病过程，包括无症状状态和死亡。治疗包括单独对症药物治疗或与 SCIT 联合治疗。该模型比较了增加和现状治疗率的两种策略。转移概率基于常规数据。成本从社会角度计算，采用德国单位成本计算文献中资源消耗的成本。QALYs 通过将非偏好基础生活质量评分的平均变化转化为效用变化来确定。关键参数进行了确定性敏感性分析。
提高治疗率是一种具有成本效益的策略，与现状相比，增量成本效益比（ICER）为 3484 欧元/QALY。最具影响力的参数是 SCIT 停药率、治疗对转移概率的影响和 SCIT 的成本。在所有参数变化中，最佳情况下，增加治疗率具有优势，而最差情况下的 ICER 为 34315 欧元/QALY。排除间接成本会使 ICER 增加一倍。
应采取措施提高 SCIT 起始率，并解决提高依从性的问题。
