ECONOMIC-EVALUATION OF RIBOSOMAL IMMUNOTHERAPY IN PATIENTS WITH CHRONIC EAR, NOSE AND THROAT AND RESPIRATORY-TRACT INFECTIONS - RESULTS FORITALY

Objective: This study analyses the economic value of ribosomal immunot herapy(1) in patients with chronic ear, nose and throat (ENT) infectio ns and respiratory tract infections (RTI) as compared with patients no t receiving prophylaxis. Specifically, the objective was to determine whether the incremental costs of ribosomal immunotherapy could be offs et by healthcare savings through a reduction in recurrent episodes of acute infection. Design and Setting: The study was conducted from the payer perspective in the Italian healthcare setting. A 6-month time-fr ame was used in the decision analysis model, and costs reflect 1995 va lues. The model incorporated international clinical trial data and Ita lian resource use data for adult patients with chronic sinusitis and b ronchitis and children with recurrent ENT infections. Main Outcome Mea sures and Results: The findings indicate that ribosomal immunotherapy is capable of generating net direct cost savings over 6 months ranging between 280 000 and 1 100 000 Italian lire (L) per patient (L1700 app roximate to $US1) depending on the type of chronic disease studied (ot itis media or rhinopharyngitis in children, sinusitis or bronchitis in adults). Threshold incremental efficacy of immunoprophylaxis required to achieve cost equivalence compared with no prophylaxis ranged betwe en 2 and 20%, depending on the indication and the magnitude of treatme nt cost associated with an acute infectious episode (low/best/high est imate) considered. In view of the incremental efficacy rates observed in clinical trials ranging between 40 and 65 % for patients with ribos omal immunoprophylaxis, prevention of recurrent ENT infections and RTI appears to be an economically meaningful therapeutic strategy, even w hen assuming that efficacy rates achievable in real clinical practice may be lower than those reported in clinical trials. Conclusion: On th e basis of these findings for Italy, physicians should give increased attention to ribosomal immunoprophylaxis of chronic respiratory diseas es in children and adults.