Economic Evaluation of 5-Grass Pollen Tablets Versus Placebo in the Treatment of Allergic Rhinitis in Adults

Background Allergen immunotherapy (AIT) is aimed at\r\nmodifying the immune response to a causative allergen,\r\nthereby reducing clinical symptoms and symptomatic\r\nmedication intake and improving quality of life. Long-term\r\nAIT research has led to the development of 5-grass pollen\r\ntablets, currently indicated for the treatment of grass polleninduced\r\nallergic rhinitis (AR).\r\nMethods A post-hoc analysis was conducted using the\r\nAverage Adjusted Symptom Score (AAdSS) to compare\r\nthe effect of treatment of AR with 5-grass pollen tablets\r\nversus placebo treatment. Using the results of the VO34.04\r\nand VO53.06 trials and economic data, cost-effectiveness\r\nanalysis of 5-grass pollen tablet treatment was performed\r\nfrom the Italian third-party payer perspective with cost data\r\nderived from a study of 2008 updated to 2011. Also a\r\nsocietal perspective was considered by using the costs\r\nrelated to the losses of productivity by following the human\r\ncapital approach. Using the results of the analysis, the\r\nestimated receiver-operating characteristic curve was\r\nplotted to evaluate medication effectiveness in terms of\r\nquality-adjusted life years (QALYs) and a decision tree\r\nconstructed to model the possible outcomes and costs for\r\nadults and paediatric patients with a low, medium, and high\r\nAAdSS. Finally, probabilistic sensitivity analysis was\r\nconducted to test the robustness of the results as well as\r\ntheir consistency at an assumed cost-effectiveness threshold\r\nof € 30,000/QALY.\r\nResults The results indicate that compared to the placebo,\r\nthe 5-grass pollen tablet treatment provides a benefit of\r\n0.127 QALYs in medium AAdSS patients and of 0.143\r\nQALYs in high AAdSS patients. The 5-grass pollen tablet\r\ntreatment was found to cost € 1,024/QALY for patients\r\nwith a medium AAdSS and € 1,035/QALY for patients\r\nwith a high AAdSS. Of all the simulations performed in the\r\nprobabilistic sensitivity analysis, 99 % indicated that the\r\nincremental cost-effectiveness ratio of the 5-grass pollen\r\ntablet treatment was below the threshold of € 30,000/\r\nQALY in patients with medium and high AAdSS, whereas\r\nit was found to be dominated in 67 % of simulations\r\nrelated to patients with low AAdSS.\r\nConclusion The 5-grass pollen tablet is a cost-effective\r\ntreatment for adult AR patients with a medium or high\r\nAAdSS. This finding should be carefully considered when\r\ndeciding the management strategy for these patients.