title: Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany.
abstract: OBJECTIVE
  An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis.
  
  
  METHODS
  The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant's perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses.
  
  
  RESULTS
  In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of -€1142 (95%CI: -€1255; -€1038) and -€54 (95%CI: -€188; €85) and incremental QALYs of 0.015 (95%CI: -0.025; 0.056) and 0.027 (95%CI: -0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the requirement of an indirect comparison involving several steps to assess relative treatment effects.
  
  
  CONCLUSIONS
  The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.
authors.affiliation: Pharmerit International, Rotterdam, The Netherlands. kwesterhout@pharmerit.com
authors.forename: K Y
authors.initials: KY
authors.lastname: Westerhout
authors.forename: B G
authors.initials: BG
authors.lastname: Verheggen
authors.forename: C H
authors.initials: CH
authors.lastname: Schreder
authors.forename: M
authors.initials: M
authors.lastname: Augustin
mesh_terms: D000328:Adult; D052179:Antigens, Plant / Q000276:immunology; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000191:economics*; D005858:Germany; D006801:Humans; D006109:Poaceae / Q000009:adverse effects* / Q000276:immunology; D011058:Pollen / Q000009:adverse effects / Q000276:immunology*; D019057:Quality-Adjusted Life Years; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D052179:Antigens, Plant