Published Online: February 1, 2013
Allergic rhinitis (AR), which affects approximately 1 in 5 Americans, is associated with substantial clinical and economic burden. In 2005, the estimated total direct U.S. costs of AR exceeded $11 billion. Prescription medications accounted for more than half of these costs. Allergy-specific immunotherapy (AIT) is the only available treatment for AR that is potentially curative and may prevent the progression from AR to asthma. Previous research demonstrated that AIT significantly reduced health care use and costs among Medicaid children with AR.
In a study recently published in The Journal of Allergy & Clinical Immunology (JACI), Hankin and colleagues examined whether the benefits would also extend to adults with AR. The investigators conducted a retrospective matched cohort study to compare the health care outcomes of children and adults with newly-diagnosed AR who subsequently received AIT to outcomes of a control group of children and adults with newly-diagnosed AR who did not received AIT. Each eligible AIT-treated patient was matched with up to 5 controls on age at first AR diagnosis, sex, race/ethnicity, comorbid illness burden, and presence of allergy-related illnesses. The authors examined rates and costs of health care utilization during the 18 months following AIT initiation (or comparable period for matched control subjects). Analyses were conducted for the total sample and separately for adults (age >18 years) and children (age <18 years).
Overall results (adults and children combined) showed that AIT-treated patients incurred 38% lower average total 18-month health care costs ($6,637 versus $10,664, P <.0001), as well as significantly lower costs for inpatient (41% lower), outpatient (57% lower), and pharmacy services (18% lower), than matched controls who did not receive AIT. These significant differences in health care costs were seen 3 months after initiation of AIT and continued throughout the 18-month follow-up period. Average 18-month cost savings per patient were $4,397 (30%) for adults and $3,965 (42%) for children. The magnitude of savings realized for AIT-treated adults and children did not significantly differ (P= 0.435). The authors concluded that the degree of benefit conferred by AIT that is previously reported for children with AR and that is confirmed in this study similarly extends to adults with AR.
The authors note that this is the first “real world” study to demonstrate significant cost benefits associated with AIT among US adults. They also note that the benefits of AIT may not be fully realized because many potentially appropriate AIT candidates do not receive treatment or an appropriate course of therapy. The authors call for coordinated efforts to reduce the US public health burden of AR and AR-related disease progression by improving AIT access, adoption, and adherence.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.