title: Economic Evaluation of Quality-of-Life Improvement with Second-Generation Antihistamines and Montelukast in Patients with Allergic Rhinitis.
abstract: BACKGROUND
  Allergic rhinitis causes significant economic losses and substantial reductions in quality of life. Improving a patient's symptoms can therefore enhance the patient's quality of life.
  
  
  OBJECTIVE
  To measure the relative cost-effectiveness of prescription second-generation antihistamines (levocetirizine, desloratadine, and fexofenadine) and montelukast based on their impact on quality of life in patients with uncomplicated allergic rhinitis.
  
  
  METHODS
  A retrospective, cost-effectiveness model was constructed using 1-year costs to managed care payers and using the Rhinoconjunctivitis Quality of Life Questionnaire to measure the quality of life in patients taking prescription second-generation antihistamines or montelukast for the treatment of allergic rhinitis. Clinical trial results for levocetirizine, desloratadine, fexofenadine (brand and generic), or montelukast were combined as standardized mean differences to create a pooled effectiveness measure. The costs of prescription drugs and physician office visits for allergic rhinitis were used as direct costs measures. Sensitivity was assessed by a Monte Carlo simulation run 1000 times.
  
  
  RESULTS
  All the drugs in the study showed significant improvement in quality of life, with levocetirizine showing the greatest improvement. The incremental cost-effectiveness of levocetirizine dominated montelukast (incremental cost-effective ratio, -1317; 95% confidence interval, -7471, -212). The incremental cost-effectiveness favored levocetirizine compared with desloratadine and branded fexofenadine.
  
  
  CONCLUSIONS
  There are significant differences in the cost-effectiveness of various oral prescription agents with regard to improving quality of life of patients with allergic rhinitis.
authors.affiliation: Graduate student in Pharmaceutical Economics, Policy, and Outcomes, University of Arizona College of Pharmacy, Tucson.
authors.forename: Kim R
authors.initials: KR
authors.lastname: Saverno
authors.affiliation: Senior Director, sanofi-aventis, Bridgewater, NJ.
authors.forename: Brian
authors.initials: B
authors.lastname: Seal
authors.affiliation: Assistant Professor, University of Utah College of Pharmacy, Salt Lake City.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goodman
authors.affiliation: Associate Director, Xcenda, Palm Harbor, FL.
authors.forename: Kellie
authors.initials: K
authors.lastname: Meyer