Costs of second-generation antihistamines in the treatment of allergic rhinitis: US perspective.
OBJECTIVE
To review the pharmacoeconomic literature evaluating use of antihistamines in treating allergic rhinitis (AR) in the US.


METHODS
Three independent reviewers conducted a comprehensive search of the current literature with PubMed. They identified articles describing original research comprising US cost analyses or pharmacoeconomic evaluations that reported both costs and consequences of using second-generation anthistamines (SGAs), first-generation antihistamines (FGAs), or both for the treatment of patients with AR. The search was limited to studies performed in humans and published in English between 1998 and 2008.


RESULTS
Five of 200 articles met the inclusion criteria and examined costs associated primarily with chlorpheniramine, diphenhydramine, cetirizine, and fexofenadine. The first two studies retrospectively analyzed a claims database and concluded that fexofenadine was associated with slightly lower overall costs than loratadine and cetirizine. A third study compared total healthcare costs associated with FGAs and SGAs, concluding that despite their higher prescription cost, SGAs result in lower medical resource use and lower cost for treatment of AR versus FGAs, although no individual SGA could be distinguished as providing substantial healthcare cost savings or increased cost-effectiveness over the other SGAs. Two studies investigated the impact of transitioning a prescription SGA to over-the-counter status and concluded that such a transition would provide cost savings to healthcare plans, but did not address the cost or health effect of such a switch on specific populations whose plans might no longer cover prescription SGAs.


CONCLUSIONS
Preliminary evidence suggests that newer SGAs offer clinical, pharmacodynamic, and pharmacokinetic advantages that may translate into superior cost-effectiveness in the treatment of AR. Further study is warranted to clarify the pharmacoeconomic impact of the newer SGAs and to establish their relative cost-effectiveness.
University of Southern California Center for the Health Professions, Los Angeles, CA 90033, USA. jhay@usc.edu
Joel W
JW
Hay
Michael A
MA
Kaliner
D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000191:economics; D062787:Drug Overdose; D017048:Health Care Costs; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D039563:Histamine H1 Antagonists, Non-Sedating / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D014481:United States; D028761:Withholding Treatment
D006634:Histamine H1 Antagonists; D039563:Histamine H1 Antagonists, Non-Sedating