Economic evaluation of specific immunotherapy versus symptomatic treatmentof allergic rhinitis in Germany

Objective: To use published data to compare the economic consequences of sp ecific immunotherapy (SIT) lasting 3 years with those of continuous symptom atic treatment in patients with either pollen or mite allergy. Design and setting: The evaluation was conducted from the following 3 persp ectives in Germany: (i) society; (ii) healthcare system; and (iii) statutor y health insurance (SHI) provider. A modelling approach was used which was based on secondary analysis of existing data. The follow-up period was 10 y ears. The break-even point of cumulated costs, their difference per patient and the additional cost per additional patient free from asthma symptoms [ incremental cost-effectiveness ratio (ICER)] were used as target variables, each from the viewpoint of SIT. The types of costs were direct and indirec t (society), direct (healthcare system) and those incurred by SHI (i.e. exp enses). In the base-case analysis, the average values of the clinical param eters and average case-related costs/expenses were applied. Main outcome measures and results: The break-even point was reached between year 6 and year 8 after the start of therapy, resulting in net savings of between 650 and 1190 deutschmarks (DM) per patient after 10 years. The ICER s of SIT were between -DM3640 and -DM7410, depending on study perspective a nd nature of the allergy (1990 values for symptomatic treatment and treatme nt of asthma, 1995 values for SIT; DM 1 approximate to $US0.58). The sensit ivity analysis demonstrated the robustness of the model and its results. Fi rst, all the independent variables of the model were varied. Secondly, the influence of the model variables was quantified using a deterministic model . SIT was more likely to result in net savings than in additional costs. An economic parameter (cost for symptomatic treatment) had the highest influe nce on the results. Conclusions: This evaluation showed that SIT for 3 years is economically ad vantageous in patients who are allergic to pollen or mites and whose sympto ms are inadequately controlled by continuous symptomatic treatment. After 1 0 years, the administration of SIT leads to net savings from the perspectiv es of society, the healthcare system and SHI (third-party payer) in Germany .