Cost-effectiveness of subcutaneous immunotherapy for house dust mite-induced allergic rhinitis in China

Abstract

Background: Limited cost-effectiveness studies have evaluated the long-term efficacy of subcutaneous immunotherapy (SCIT).

Objective: This study's objective was to analyze the cost-effectiveness of house dust mite-specific SCIT (HDM-SCIT), including post-SCIT efficacy, in allergic rhinitis (AR) patients.

Methods: In this retrospective study, the post-treatment period ranged from 1 year to 13 years. The costs included the direct cost of HDM-SCIT, and the actual AR treatment cost estimated by the patients at different follow-up stages.

Results: The median annual cost of AR treatment before, during, and after HDMSCIT was 1,000, 6,000, and 300 RMB/year, respectively. A moderate negative correlation was found between the post-SCIT period and the CUR of SCIT with longterm efficacy (r = -0.545, p < 0.001). The combined long-term efficacy CUR of SCIT within 5 years (including 5 years) post-SCIT was significantly higher than that in the pre-SCIT period. However, the subgroups that had completed SCIT for 6 years or longer showed no difference. For HDM-SCIT in China, the direct ICER (18,269 RMB/QALY) and actual ICER (19,549 RMB/QALY) were both lower than the average per capita gross domestic product (GDP) from 2005 to 2020 (41,469 RMB/year).

Conclusion: HDM-SCIT is highly cost-effective in treating AR in China. The addition of SCIT to pharmacotherapy can further improve the quality of life in patients with AR. For patients who gained long-term efficacy of HDM-SCIT for 6 years or more, the application of SCIT would not increase the actual costs of AR treatment.

Keywords

allergic rhinitis / cost effectiveness / dust mites / long term / subcutaneous immunotherapy

References

[1] Cheng L , Chen J , Fu Q , et al. Chinese society of allergy guidelines for diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res. 2018; 10 (4): 300- 353.

[2] Li X , Xu X , Li J , et al. Direct and indirect costs of allergic and nonallergic rhinitis to adults in Beijing, China. Clin Transl Allergy. 2022; 12 (4): e12148.

[3] Bousquet J , Khaltaev N , Cruz AA , et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy. 2008; 63 (suppl 86): 8- 160.

[4] Kim JY , Jang MJ , Kim DY , Park SW , Han DH . Efficacy of subcutaneous and sublingual immunotherapy for house dust mite allergy: a network meta-analysis-based comparison. J Allergy Clin Immunol Pract. 2021; 9 (12): 4450- 4458.e6.

[5] Chen J , Xiang J , Wang Y , Shi Q , Tan H , Kong W . [Health economics analysis of specific immunotherapy in allergic rhinitis accompanied with asthma]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013; 27 (17): 925- 928.

[6] Wang C , Bao Y , Chen J , et al. Chinese guideline on allergen immunotherapy for allergic rhinitis: the 2022 update. Allergy Asthma Immunol Res. 2022; 14 (6): 604- 652.

[7] Suratannon N , Limsuwan T , Tantilipikorn P , et al. A large scale multicentre randomized, placebo-controlled subcutaneous house dust mite allergen immunotherapy (HDM SCIT) in allergic rhinitis: MITAR study. Asian Pac J Allergy Immunol. 2024; 42 (3): 233- 245.

[8] Huang Y , Wang C , Cao F , Zhao Y , Lou H , Zhang L . Comparison of long-term efficacy of subcutaneous immunotherapy in pediatric and adult patients with allergic rhinitis. Allergy Asthma Immunol Res. 2019; 11 (1): 68- 78.

[9] Peng H , Li CW , Lin ZB , Li TY . Long-term efficacy of specific immunotherapy on house dust mite-induced allergic rhinitis in China. Otolaryngol Head Neck Surg. 2013; 149 (1): 40- 46.

[10] Jutel M , Brüggenjürgen B , Richter H , Vogelberg C . Real-world evidence of subcutaneous allergoid immunotherapy in house dust mite-induced allergic rhinitis and asthma. Allergy. 2020; 75 (8): 2050- 2058.

[11] Ren L , Wang C , Xi L , Gao Y , Zhang Y , Zhang L . Long-term efficacy of HDM-SCIT in pediatric and adult patients with allergic rhinitis. Allergy Asthma Clin Immunol. 2023; 19 (1): 20.

[12] Silva D , Pereira A , Santos N , Plácido JL . Costs of treatment affect compliance to specific subcutaneous immunotherapy. Eur Ann Allergy Clin Immunol. 2014; 46 (2): 87- 94.

[13] Keiding H , Jørgensen KP . A cost-effectiveness analysis of immunotherapy with SQ allergen extract for patients with seasonal allergic rhinoconjunctivitis in selected European countries. Curr Med Res Opin. 2007; 23 (5): 1113- 1120.

[14] Liu GG , Guan H , Jin X , Zhang H , Vortherms SA , Wu H . Rural population's preferences matter: a value set for the EQ-5D-3L health states for China's rural population. Health Qual Life Outcome. 2022; 20 (1): 14.

[15] Liu GG , Wu H , Li M , Gao C , Luo N . Chinese time trade-off values for EQ-5D health states. Value Health. 2014; 17 (5): 597- 604.

[16] Di Bona D , Bilancia M , Albanesi M , Caiaffa MF , Macchia L . Cost-effectiveness of grass pollen allergen immunotherapy in adults. Allergy. 2020; 75 (9): 2319- 2329.

[17] Richter AK , Klimek L , Merk HF , et al. Impact of increasing treatment rates on cost-effectiveness of subcutaneous immunotherapy (SCIT) in respiratory allergy: a decision analytic modelling approach. Eur J Health Econ. 2018; 19 (9): 1229- 1242.

[18] Di Rienzo V , Marcucci F , Puccinelli P , et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy. 2003; 33 (2): 206- 210.

RIGHTS & PERMISSIONS

The Author(s). Eye & ENT Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.