Optimizing quality of care and cost effectiveness in treating allergic rhinitis in a managed care setting

Allergic rhinitis is a common condition in managed care populations. The di rect medical cost of rhinitis exceeded $3 billion in 1996, and an additiona l cost of $4 billion resulted from the exacerbation of other concomitant co nditions, such as asthma or otitis media. Costs continued to increase in 19 99; sales of prescription antihistamines and nasal steroids exceeded $3 bil lion and $1 billion, respectively. The indirect costs of allergic rhinitis include lost work productivity, reduced performance and learning, and incre ased workplace and traffic accidents. Rhinitis treatments include allergen avoidance, over-the-counter (OTC) sedating antihistamines, nonsedating anti histamines, nasal steroids, and immunotherapy. Allergen avoidance strategie s for patients with asthma and rhinitis are ineffective or are of very limi ted benefit. Allergists criticize the use of OTC sedating antihistamines, w hich are associated with reduced learning and performance even when sedatio n does not occur. Evidence-based literature reviews of clinical trials have shown that nasal steroids are more effective than nonsedating antihistamin es in the treatment of rhinitis. The most commonly prescribed nasal steroid , fluticasone, has been shown to be effective in treating rhinitis and in i mproving patients' quality of life. It is also more cost effective than the most commonly prescribed antihistamine, loratadine. Clinical trials have i ndicated that immunotherapy is expensive and of limited benefit. As these e vidence-based findings are used to develop managed care treatment guideline s, nasal steroids are likely to be recommended as the first-line treatment for rhinitis, which should result in lower treatment costs and improved out comes for patients with rhinitis.