a Optum , Eden Prairie , MN , USA.
b Center for Observational and Real-World Evidence , Merck, Sharp, & Dohme Inc. , Lebanon , NJ , USA.
Curr Med Res Opin. 2019 Feb;35(2):351-358. doi: 10.1080/03007995.2018.1510386. Epub 2018 Sep 12.
Allergic rhinitis (AR) affects up to 40% of the United States population, with approximately $11 billion annual medical costs. Allergy immunotherapy is the best option for long-term symptomatic relief, but treatment compliance can be low. The objective was to describe subcutaneous immunotherapy (SCIT)-related costs for patients overall and those with inconsistent treatment.
This study observed commercial and Medicare Advantage with Part D health plan enrollees. Included subjects had claims with AR diagnostic codes during 1 January 2011-31 December 2015 and ≥1 SCIT claim during 1 January 2013-31 December 2015 (index date = first SCIT claim date). A control sample was chosen randomly at a 1:3 ratio of SCIT to controls. Inconsistent use was defined as a ≥90 day gap after ≥1 SCIT. Patient characteristics were compared between SCIT patients and controls. Costs were calculated for all SCIT patients and the inconsistent subgroup.
Compared with controls (n = 394,479), SCIT (n = 131,493) patients were younger (39.3 vs. 41.4 years), more likely female (56.4% vs. 50.7%) and more likely in a commercial plan (91.6% vs. 83.6%); all p < .001. Among SCIT patients, 15.1% had inconsistent use. Among all SCIT patients, the 3 year total plan-paid SCIT-related costs were $205,741,125 (18% was for inconsistent subgroup) and patient-paid costs were $47,560,450 (15% for inconsistent). Per-member-per-month costs were $0.48 plan-paid and $0.11 patient-paid, with $0.09 plan-paid and $0.02 patient-paid for inconsistent use.
This study showed 15% of patients may have costly inconsistent SCIT treatment. Greater understanding is needed regarding the reasons for inconsistent use of subcutaneous allergy immunotherapy.
过敏性鼻炎（AR）影响了美国多达 40%的人口，其年医疗费用约为 110 亿美元。过敏免疫疗法是长期缓解症状的最佳选择，但治疗依从性可能较低。本研究旨在描述总体上接受皮下免疫疗法（SCIT）的患者以及治疗不规律患者的 SCIT 相关费用。
本研究观察了商业和 Medicare Advantage 与 Part D 健康计划的参保者。纳入研究的受试者在 2011 年 1 月 1 日至 2015 年 12 月 31 日期间有 AR 诊断代码的索赔，在 2013 年 1 月 1 日至 2015 年 12 月 31 日期间有 ≥1 次 SCIT 索赔（索引日期=首次 SCIT 索赔日期）。SCIT 组与对照组的比例为 1:3。不规律使用定义为在 ≥1 次 SCIT 后至少 90 天的差距。比较 SCIT 患者和对照组的患者特征。计算所有 SCIT 患者和不规律亚组的费用。
与对照组（n=394479）相比，SCIT 患者（n=131493）更年轻（39.3 岁 vs. 41.4 岁），女性比例更高（56.4% vs. 50.7%），更有可能参加商业计划（91.6% vs. 83.6%）；所有 p 值均＜0.001。在 SCIT 患者中，有 15.1%的患者存在不规律使用。在所有 SCIT 患者中，3 年总计划支付的 SCIT 相关费用为 20574.125 万美元（18%用于不规律亚组），患者自付费用为 4756.045 万美元（15%用于不规律）。每位会员每月的计划支付费用为 0.48 美元，患者自付费用为 0.11 美元，不规律使用的计划支付费用为 0.09 美元，患者自付费用为 0.02 美元。
本研究显示，15%的患者可能存在费用较高的不规律 SCIT 治疗。需要进一步了解皮下过敏免疫疗法不规律使用的原因。
