BOLETÍN BIBLIOGRÁFICO
DE INMUNOTERAPIA
Artículo destacado – Febrero 2020
1
Coste-efectividad de la ITE: cara a cara entre ITSC e ITSL.
Cost-effectiveness of grass pollen allergen immunotherapy in adults.
Di Bona D, Bilancia M, Albanesi M, Caiaffa MF, Macchia L
Allergy. 2020 Feb 24. doi: 10.1111/all.14246. [Epub ahead of print]
BACKGROUND
Major scientific societies, such as the EAACI or the AAAAI, do not express any suggestion on which form of allergen immunotherapy (AIT) is to be preferred (subcutaneous immunotherapy, SCIT, vs. sublingual immunotherapy, SLIT). This choice could depend on their relative pharmacoeconomic value.
OBJECTIVES
To assess the cost-effectiveness of AIT for grass pollen, administered as SCIT or SLIT.
METHODS
We created a Markovian Model, to evaluate, in a hypothetical cohort of adult patients suffering from moderate-to-severe rhino-conjunctivitis with or without allergic asthma, the cost-effectiveness of SLIT (tablets, Grazax® and Oralair® ) or SCIT (various currently available products, plus indirect non-medical costs, such as travel and productivity costs) in addition to pharmacological therapy, assuming a 9-year horizon to capture AIT long-term effects. The incremental cost-effectiveness ratio (ICER) was calculated assuming pharmacological therapy as the reference comparator.
RESULTS
In the base-case, SCIT was slightly more expensive, but more effective than SLIT, being the most cost-effective option (ICER for SCIT, €11,418; ICER for SLIT, €15,212). ICERs greater than €120,000 for both SCIT and SLIT was demonstrated in a scenario assuming that low treatment persistence rates, which are common in real-life, lead to absence of long-term AIT clinical benefit. Considering indirect non-medical costs SLIT resulted more cost-effective than SCIT (ICER for SCIT, €17,318; ICER for SLIT, €15,212).
CONCLUSIONS
In daily practice AIT for grass pollens may be a cost-effective option only in patients with low discontinuation rates. SCIT, which is less affected by this limitation than SLIT, seems the most cost-effective AIT form.