title: Real-life compliance and persistence among users of subcutaneous and sublingual allergen immunotherapy.
abstract: BACKGROUND
  Subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT) are safe and effective treatments of allergic rhinitis, but high levels of compliance and persistence are crucial to achieving the desired clinical effects.
  
  
  OBJECTIVE
  Our objective was to assess levels and predictors of compliance and persistence among grass pollen, tree pollen, and house dust mite immunotherapy users in real life and to estimate the costs of premature discontinuation.
  
  
  METHODS
  We performed a retrospective analysis of a community pharmacy database from The Netherlands containing data from 6486 patients starting immunotherapy for 1 or more of the allergens of interest between 1994 and 2009. Two thousand seven hundred ninety-six patients received SCIT, and 3690 received SLIT. Time to treatment discontinuation was analyzed and included Cox proportional hazard models with time-dependent covariates, where appropriate.
  
  
  RESULTS
  Overall, only 18% of users reached the minimally required duration of treatment of 3 years (SCIT, 23%; SLIT, 7%). Median durations for SCIT and SLIT users were 1.7 and 0.6 years, respectively (P < .001). Other independent predictors of premature discontinuation were prescriber, with patients of general practitioners demonstrating longer persistence than those of allergologists and other medical specialists; single-allergen immunotherapy, lower socioeconomic status; and younger age. Of the persistent patients, 56% were never late in picking up their medication from the pharmacy. Direct medication costs per nonpersistent patient discontinuing in the third year of treatment were €3800, an amount that was largely misspent.
  
  
  CONCLUSIONS
  Real-life persistence is better in SCIT users than in SLIT users, although it is low overall. There is an urgent need for further identification of potential barriers and measures that will enhance persistence and compliance.
authors: Institute for Medical Technology Assessment, Department of Health Economics (iMTA), Erasmus University, Rotterdam, The Netherlands. kiel@bmg.eur.nl
authors: Menno A
authors: MA
authors: Kiel
authors: Esther
authors: E
authors: Röder
authors: Roy
authors: R
authors: Gerth van Wijk
authors: Maiwenn J
authors: MJ
authors: Al
authors: Wim C J
authors: WC
authors: Hop
authors: Maureen P M H
authors: MP
authors: Rutten-van Mölken
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology; D000818:Animals; D003888:Desensitization, Immunologic / Q000191:economics / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology; D039981:Pyroglyphidae; D012189:Retrospective Studies; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000209:etiology / Q000628:therapy*; D014197:Trees / Q000276:immunology
chemical_list: D000485:Allergens
keywords: Allergic rhinitis; GP; Grass pollen; HDM; HR; Hazard rate; House dust mite; SCIT; SES; SLIT; Socioeconomic status; Subcutaneous allergen immunotherapy; Sublingual allergen immunotherapy; TP; Tree pollen; WHO; World Health Organization; adherence; compliance; cost; persistence; specific allergen immunotherapy; subcutaneous; subcutaneous allergen immunotherapy; sublingual; sublingual allergen immunotherapy