title: Outcomes and cost comparison of three therapeutic approaches to allergic rhinitis.
abstract: BACKGROUND
  Allergic rhinitis (AR) is a global health problem because of its increasing impact on economics, society, and the individual's quality of life. This study compares the outcomes and cost of three intranasal therapeutic approaches to the treatment of AR.
  
  
  METHODS
  This was a retrospective cohort study using propensity scores to achieve balanced cohorts. The study population included patients ≥16 years of age with at least one intranasal prescription claim, without concurrent nasal polyps or sinusitis. Health care use and costs, airway infections, pharmacy costs, and indicators of unsatisfactory treatment (i.e., treatment augmentation or switching) were evaluated in the 1-year follow-up period using a claims database.
  
  
  RESULTS
  Data from 141,190 patients in intranasal antihistamines (INA) therapy, intranasal steroids (INS) therapy, and intranasal combination therapy (ICT) cohorts were analyzed. The INA cohort showed the lowest rate of change in treatment (switching or augmentation). Switching rates were lowest in the INS therapy cohort, whereas augmentation was lowest in the INA cohort. AR- and asthma-related medication costs were significantly lower in the INA cohort. No differences were observed in airway infections and overall health care costs. Concurrent chronic obstructive pulmonary disorder and asthma were the strongest predictors of health care cost and respiratory infection in the follow-up period.
  
  
  CONCLUSIONS
  A change in treatment was noted in ∼⅓ of the entire study population. None of the treatments had a remarkable effect on health care costs or the occurrence of airway infections. The INA treatment cohort had lower AR- and asthma-related medication costs.
authors.affiliation: Alcon Laboratories, Inc., Fort Worth, TX 76134, USA. carol.fairchild@alconlabs.com
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Fairchild
authors.forename: Emily
authors.initials: E
authors.lastname: Durden
authors.forename: Zhun
authors.initials: Z
authors.lastname: Cao
authors.forename: Patrick
authors.initials: P
authors.lastname: Smale
mesh_terms: D000281:Administration, Intranasal; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006633:Histamine Antagonists / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D013256:Steroids / Q000191:economics* / Q000627:therapeutic use
chemical_list: D006633:Histamine Antagonists; D013256:Steroids