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. 2018 Dec;19(9):1229-1242.
doi: 10.1007/s10198-018-0970-6. Epub 2018 Mar 24.

Impact of increasing treatment rates on cost-effectiveness of subcutaneous immunotherapy (SCIT) in respiratory allergy: a decision analytic modelling approach

Ann-Kathrin Richter  1 , Ludger Klimek  2 , Hans F Merk  3 , Norbert Mülleneisen  4 , Harald Renz  5 , Wolfgang Wehrmann  6 , Thomas Werfel  7 , Eckard Hamelmann  8 , Uwe Siebert  9   10   11 , Gaby Sroczynski  9 , Jürgen Wasem  12 , Janine Biermann-Stallwitz  12
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Impact of increasing treatment rates on cost-effectiveness of subcutaneous immunotherapy (SCIT) in respiratory allergy: a decision analytic modelling approach

Ann-Kathrin Richter et al. Eur J Health Econ. 2018 Dec.

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusions: Measures to increase SCIT initiation rates should be implemented and also address improving adherence.

Keywords: Cost-utility analysis; Markov process; Respiratory allergy; State-transition model; Subcutaneous immunotherapy.

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