title: Cost-effectiveness of specific subcutaneous immunotherapy in patients with allergic rhinitis and allergic asthma.
abstract: BACKGROUND
  Specific immunotherapy is the only potentially curative treatment in patients with allergic rhinitis and allergic asthma. Health economic evaluations on this treatment, particularly in a German context, are sparse.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of specific subcutaneous immunotherapy (SCIT) in addition to symptomatic treatment (ST) compared with ST alone in a German health care setting.
  
  
  METHODS
  The analysis was performed as a health economic model calculation based on Markov models. In addition, we performed a concomitant expert board composed of allergy experts in pediatrics, dermatology, pneumology, and otolaryngology. The primary perspective of the study was societal. Additional sensitivity analyses were performed to prove our results for robustness.
  
  
  RESULTS
  The SCIT and ST combination was associated with annual cost savings of Euro140 per patient. After 10 years of disease duration, SCIT and ST reach the breakeven point. The overall incremental cost-effectiveness ratio (ICER) was Euro-19,787 per quality-adjusted life-year (QALY), with a range that depended on patient age (adults, Euro-22,196; adolescents, Euro-14,747; children, Euro-12,750). From a third-party payer's perspective, SCIT was associated with slightly additional costs. Thus, the resulting ICER was Euro8,308 per QALY for all patients.
  
  
  CONCLUSIONS
  Additional SCIT was associated with improved medical outcomes and cost savings compared with symptomatic treatment alone according to a societal perspective. Taking a European accepted ICER threshold of up to Euro50,000 per QALY into account, additional SCIT is considered clearly cost-effective compared with routine care in Germany. The degree of cost-effectiveness is strongly affected by costs related to SCIT and the target population receiving such treatment.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-University Medical Center, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Brüggenjürgen
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhold
authors.forename: Randolf
authors.initials: R
authors.lastname: Brehler
authors.forename: Eckard
authors.initials: E
authors.lastname: Laake
authors.forename: Günther
authors.initials: G
authors.lastname: Wiese
authors.forename: Ulrich
authors.initials: U
authors.lastname: Machate
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000191:economics* / Q000379:methods; D005858:Germany; D006801:Humans; D007279:Injections, Subcutaneous; D008390:Markov Chains; D008875:Middle Aged; D012221:Rhinitis, Allergic, Perennial / Q000191:economics / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome