title: An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease.
abstract: BACKGROUND
  Aspirin desensitization is an effective therapy for moderate-to-severe aspirin-exacerbated respiratory disease (AERD). Desensitization also allows the use of aspirin for secondary cardiovascular prevention.
  
  
  OBJECTIVE
  We sought to investigate the cost-effectiveness of aspirin desensitization with subsequent aspirin therapy in patients with AERD.
  
  
  METHODS
  The Healthcare Cost and Utilization Project was used, together with average reimbursements from a large Midwestern health care plan, to model the costs of aspirin desensitization for therapeutic and prophylactic use in patients with AERD. Event probabilities were based on the published literature.
  
  
  RESULTS
  Ambulatory desensitization for AERD cost $6768 per quality-adjusted life year (QALY) saved ($18.54 per additional symptom-free day). Aspirin desensitization for AERD remained cost-effective (<$50,000 per QALY saved) across a wide range of assumptions. When secondary cardiovascular prophylaxis was considered, ambulatory aspirin desensitization was less expensive than an alternative antiplatelet agent, clopidogrel. Clopidogrel cost $106,453 per incremental QALY saved when compared with desensitization.
  
  
  CONCLUSIONS
  Aspirin desensitization is a cost-effective therapeutic intervention in patients with moderate-to-severe AERD. Although the incremental cost-effectiveness of clopidogrel in individuals with aspirin allergy is marginal, if available, ambulatory desensitization remains a less-expensive option for secondary cardiovascular prophylaxis.
authors: Section of Allergy and Clinical Immunology, Department of Pediatrics and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Marcus.Shaker@dartmouth.edu
authors: Marcus
authors: M
authors: Shaker
authors: Ano
authors: A
authors: Lobb
authors: Pamela
authors: P
authors: Jenkins
authors: Daniel
authors: D
authors: O'Rourke
authors: Steve K
authors: SK
authors: Takemoto
authors: Salil
authors: S
authors: Sheth
authors: Thomas
authors: T
authors: Burroughs
authors: Mark S
authors: MS
authors: Dykewicz
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000191:economics* / Q000379:methods; D004342:Drug Hypersensitivity / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin