Allergy Immunotherapy: What Is the Evidence for Cost Saving?
Allergy Immunotherapy: What Is the Evidence for Cost Saving?
Purpose of review Given the widespread prevalence of allergic disease, its substantially associated clinical and economic burden, the unique disease-modifying benefits of allergy immunotherapy (AIT), and increased availability of sublingual immunotherapy (SLIT), a critical update of the evidence for AIT-related cost savings [for both subcutaneous immunotherapy (SCIT) and SLIT] is particularly relevant and timely. The present article reviews the evidence for SCIT-related and SLIT-related cost savings derived from a systematic review of the published literature.
Recent findings Examined were 24 publications pertaining to the health economics of AIT. Except for one early study comparing the costs of AIT to symptomatic drug treatment (SDT), the remainder provide compelling evidence for AIT cost savings (whether SCIT or SLIT) over SDT. Furthermore, of the six studies comparing cost outcomes of SLIT to SCIT, four reported cost savings favoring SLIT.
Summary This review, spanning research from Southern Europe, Scandinavia, Northern Europe, North America, and the Czech Republic, encompasses a range of perennial and seasonal allergic conditions, including allergic asthma, allergic rhinitis with or without asthma, and rhinoconjunctivitis with or without allergic rhinitis due to house dust mite, grass or ragweed pollen, or a mixture of various allergens. All but one study compellingly demonstrate cost savings conferred by AIT over SDT.
The global prevalence of allergic disease, in general, and allergic rhinitis, allergic conjunctivitis, allergic asthma, and atopic dermatitis, specifically, is increasing dramatically, especially within the developed countries. Allergic rhinitis alone affects approximately 500 million people worldwide, including an estimated 113 million in Europe and 30–60 million in the United States (USA).
Allergy immunotherapy (AIT) is indicated for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma in patients whose symptoms are not adequately controlled by symptomatic drug treatment (SDT) and avoidance measures, those experiencing unacceptable adverse effects from SDT, or patients who wish to reduce the long-term use of SDT.
In contrast to SDT, which offers temporary symptomatic relief, AIT holds unique distinction as the only allergy treatment known to alter the clinical course of allergic disease. AIT has the potential to halt the progression from allergic rhinitis to asthma, prevent the development of new allergies, and reduce the need and use of SDT. Improved symptoms, reduced SDT use, and favorable immunological changes (per skin prick test and serum allergen-specific antibodies) have been sustained for up to 12 years after discontinuation of a 2–5-year course of AIT.
Sublingual immunotherapy (SLIT) has garnered growing attention since three products were recently awarded approval by the U.S. Food and Drug Administration (FDA). Oralair, a once-daily SLIT dissolving tablet, became the first SLIT product to be approved for the U.S. market. Oralair is indicated for the seasonal treatment of grass-pollen-induced allergic rhinitis with or without allergic conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies (for Sweet Vernal, Orchard, Perennial Rye, Timothy, or Kentucky Blue Grass Mixed Pollens) in persons aged 10 through 65 years. Next to become FDA approved was Grastek, indicated for the seasonal treatment of grass-pollen-induced allergic rhinitis with or without allergic conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens. FDA approval was most recently awarded for Ragwitek, indicated for use as immunotherapy for the treatment of short ragweed-pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies in patients aged 18–65 years. Given the widespread prevalence of allergic disease, its substantially associated clinical and economic burden, the unique disease-modifying benefits of AIT, and increased availability of SLIT, a critical update of the evidence for AIT-related cost savings [for both subcutaneous immunotherapy (SCIT) and SLIT] is particularly relevant and timely. The present article reviews the evidence for SCIT-related and SLIT-related cost savings derived from our systematic review of the published literature.
Abstract and Introduction
Abstract
Purpose of review Given the widespread prevalence of allergic disease, its substantially associated clinical and economic burden, the unique disease-modifying benefits of allergy immunotherapy (AIT), and increased availability of sublingual immunotherapy (SLIT), a critical update of the evidence for AIT-related cost savings [for both subcutaneous immunotherapy (SCIT) and SLIT] is particularly relevant and timely. The present article reviews the evidence for SCIT-related and SLIT-related cost savings derived from a systematic review of the published literature.
Recent findings Examined were 24 publications pertaining to the health economics of AIT. Except for one early study comparing the costs of AIT to symptomatic drug treatment (SDT), the remainder provide compelling evidence for AIT cost savings (whether SCIT or SLIT) over SDT. Furthermore, of the six studies comparing cost outcomes of SLIT to SCIT, four reported cost savings favoring SLIT.
Summary This review, spanning research from Southern Europe, Scandinavia, Northern Europe, North America, and the Czech Republic, encompasses a range of perennial and seasonal allergic conditions, including allergic asthma, allergic rhinitis with or without asthma, and rhinoconjunctivitis with or without allergic rhinitis due to house dust mite, grass or ragweed pollen, or a mixture of various allergens. All but one study compellingly demonstrate cost savings conferred by AIT over SDT.
Introduction
The global prevalence of allergic disease, in general, and allergic rhinitis, allergic conjunctivitis, allergic asthma, and atopic dermatitis, specifically, is increasing dramatically, especially within the developed countries. Allergic rhinitis alone affects approximately 500 million people worldwide, including an estimated 113 million in Europe and 30–60 million in the United States (USA).
Allergy immunotherapy (AIT) is indicated for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma in patients whose symptoms are not adequately controlled by symptomatic drug treatment (SDT) and avoidance measures, those experiencing unacceptable adverse effects from SDT, or patients who wish to reduce the long-term use of SDT.
In contrast to SDT, which offers temporary symptomatic relief, AIT holds unique distinction as the only allergy treatment known to alter the clinical course of allergic disease. AIT has the potential to halt the progression from allergic rhinitis to asthma, prevent the development of new allergies, and reduce the need and use of SDT. Improved symptoms, reduced SDT use, and favorable immunological changes (per skin prick test and serum allergen-specific antibodies) have been sustained for up to 12 years after discontinuation of a 2–5-year course of AIT.
Sublingual immunotherapy (SLIT) has garnered growing attention since three products were recently awarded approval by the U.S. Food and Drug Administration (FDA). Oralair, a once-daily SLIT dissolving tablet, became the first SLIT product to be approved for the U.S. market. Oralair is indicated for the seasonal treatment of grass-pollen-induced allergic rhinitis with or without allergic conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies (for Sweet Vernal, Orchard, Perennial Rye, Timothy, or Kentucky Blue Grass Mixed Pollens) in persons aged 10 through 65 years. Next to become FDA approved was Grastek, indicated for the seasonal treatment of grass-pollen-induced allergic rhinitis with or without allergic conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens. FDA approval was most recently awarded for Ragwitek, indicated for use as immunotherapy for the treatment of short ragweed-pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or in-vitro testing for pollen-specific IgE antibodies in patients aged 18–65 years. Given the widespread prevalence of allergic disease, its substantially associated clinical and economic burden, the unique disease-modifying benefits of AIT, and increased availability of SLIT, a critical update of the evidence for AIT-related cost savings [for both subcutaneous immunotherapy (SCIT) and SLIT] is particularly relevant and timely. The present article reviews the evidence for SCIT-related and SLIT-related cost savings derived from our systematic review of the published literature.
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