Shaker Marcus, Mauger David, Fuhlbrigge Anne L
Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH.
Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, State College, Pa.
J Allergy Clin Immunol Pract. 2023 Jan;11(1):132-139. doi: 10.1016/j.jaip.2022.07.017. Epub 2022 Aug 6.
Asthma and allergic disease impact millions of patients and are associated with high costs. Up to 30% of all medical care involves wasted spending. Across the spectrum of care provided by the allergist-immunologist, there are opportunities to improve value and reduce medical waste. Several examples highlight this reality. Evidence suggests that most patients may receive cost-effective care in the management of chronic spontaneous urticaria without the need for laboratory testing. For patients with asthma, although a single maintenance and reliever therapy approach may be cost-effective, insurance-mandated therapy changes are not, and may harm patients. Biologics may be very effective in improving asthma control but are too expensive for this indication-as demonstrated by cost-effectiveness analyses and highlighted by the Institute of Clinical and Economic Review, which concluded that the value-based price for asthma biologics ranges between $6500 and 14,3000 per year. Early introduction may prevent food allergy, but screening before first introduction is neither necessary nor cost-effective, although early salvage food oral immunotherapy may result in improved quality of life and cost savings. Evidence does not support the presence of allergic disease as a risk factor for anaphylaxis to coronavirus disease 2019 vaccination, and risk-stratified vaccination approaches do not appear cost-effective. Allergen immunotherapy is a very cost-effective treatment option. The practice of allergy-immunology has continued to evolve in recent years and can provide a leading example of high-value practice.
哮喘和过敏性疾病影响着数百万患者，并带来高昂的费用。所有医疗护理中高达30%涉及浪费性支出。在过敏症专科医生-免疫学家提供的整个护理范围内，存在提高价值和减少医疗浪费的机会。几个例子凸显了这一现实。有证据表明，大多数慢性自发性荨麻疹患者在管理过程中可能无需实验室检测就能接受具有成本效益的护理。对于哮喘患者，虽然单一的维持和缓解治疗方法可能具有成本效益，但保险规定的治疗方案变更并非如此，而且可能对患者有害。生物制剂在改善哮喘控制方面可能非常有效，但对于该适应症来说过于昂贵——成本效益分析表明了这一点，临床与经济评论研究所也强调了这一点，该研究所得出结论，哮喘生物制剂基于价值的价格每年在6500美元至143000美元之间。早期引入可能预防食物过敏，但首次引入前的筛查既无必要也不具有成本效益，不过早期挽救性食物口服免疫疗法可能会改善生活质量并节省成本。没有证据支持过敏性疾病是2019冠状病毒病疫苗过敏反应的风险因素，而且风险分层的疫苗接种方法似乎也不具有成本效益。变应原免疫疗法是一种非常具有成本效益的治疗选择。近年来，过敏症-免疫学实践不断发展，可为高价值实践提供一个领先范例。
