An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease.
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.
Shaker
Marcus
M
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
Lobb
Ano
A
Jenkins
Pamela
P
O'Rourke
Daniel
D
Takemoto
Steve K
SK
Sheth
Salil
S
Burroughs
Thomas
T
Dykewicz
Mark S
MS
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
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin