EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
Allergy. 2022 Sep;77(9):2688-2698. doi: 10.1111/all.15321. Epub 2022 May 9.
Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are limited but needed to drive clinical and policy-making decisions such as reimbursement of new interventions. In this study, we compared the cost effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) tablets to the standard of care (SOC) treatment in children with house dust mite-driven (HDM) allergic asthma.
We developed a hypothetical Markov model based on the Global Initiative for Asthma (GINA) severity steps to compare the three strategies over a 10-year horizon divided by cycles of 6 months. SOC was used as a reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were used to assess models' uncertainty. Other scenarios were evaluated to strengthen the presentation of results.
The ICER for SCIT and SLIT tablets was 1281€ and 7717€, respectively. The cost-effectiveness threshold for Portugal was 18,482.80€; both treatment approaches were below this limit. The major contributors to these results were the AIT effects on reducing moderate and severe exacerbations and asthma controller medication. In the sensitivity analysis, SCIT revealed a higher probability of cost-effectiveness than SLIT. When including allergic rhinitis as comorbidity, ICER values reduced markedly, especially for SCIT intervention.
AIT was cost effective in children with HDM-driven allergic asthma, especially when given by the subcutaneous route. The high probability of cost effectiveness, especially for SCIT, may drive future policy decisions and AIT-prescribing habits. AIT adherence greatly influenced the results highlighting the value of implementing strategies to promote adherence rates.
评估变应原免疫治疗（AIT）在儿童中的成本效益的研究有限，但需要为临床和决策制定提供依据，例如新干预措施的报销。在这项研究中，我们比较了皮下（SCIT）和舌下免疫治疗（SLIT）片剂与尘螨驱动（HDM）过敏性哮喘儿童标准治疗（SOC）的成本效益。
我们根据全球哮喘倡议（GINA）严重程度步骤开发了一个假设的马尔可夫模型，以比较三种策略在 10 年的时间内，分为 6 个月的周期。SOC 被用作参考，以计算增量成本效益比（ICER）。确定性和概率敏感性分析用于评估模型的不确定性。还评估了其他方案以加强结果的呈现。
SCIT 和 SLIT 片剂的 ICER 分别为 1281€和 7717€。葡萄牙的成本效益阈值为 18482.80€；两种治疗方法均低于此限制。这些结果的主要贡献者是 AIT 对减少中重度恶化和哮喘控制药物的影响。在敏感性分析中，SCIT 比 SLIT 具有更高的成本效益概率。当包括变应性鼻炎作为合并症时，ICER 值显著降低，尤其是对于 SCIT 干预。
AIT 在 HDM 驱动的过敏性哮喘儿童中具有成本效益，尤其是通过皮下途径给予时。SCIT 尤其具有高成本效益的可能性，这可能会推动未来的政策决策和 AIT 处方习惯。AIT 的依从性对结果有很大影响，突出了实施策略以提高依从率的价值。
