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Background: Allergic rhinoconjunctivitis is a global health problem. Around 14 million people in Spain, France, Italy, and Austria suffer from grass pollen induced allergic rhinitis. Standard care only provides symptoms relief, while allergen specific immunotherapy (SIT) treats the underlying cause of the disease. Grazax from ALK-Abelló is a new, tablet-based, effective route of SIT for home treatment. The objective was to assess the cost-effectiveness of Grazax in four Southern European countries., Methods: A prospective pharmacoeconomic analyses was carried out alongside a multinational, clinical trial measuring the efficacy of Grazax. Pooled data on resource use and health outcomes were collected. A societal perspective was adopted, and the analysis had a nine-year time horizon. The primary outcome measure was quality adjusted life years (QALYs)., Results: Grazax was superior to standard care for all efficacy endpoints, including QALYs gained, and resulted in significantly less use of rescue medication and fewer hours missed from work. Grazax was cost-effective for all countries for an annual price in the range of 1500 euros - 1900 euros. The result was improved by inclusion of future costs of asthma and exclusion of Spanish trial centers which experienced an exceptionally low pollen season., Conclusion: The analysis illustrates that allergen SIT with Grazax for grass pollen induced rhinoconjunctivitis is a cost-effective intervention in Southern Europe.

Objectives: Newer oral allergic rhinitis (AR) medications, the second-generation antihistamines (SGAs) have gained widespread acceptance because of their efficacy and reduced side effects relative to first-generation antihistamines (FGAs). There are no empirical studies comparing the costs of treatment of SGAs relative to FGAs., Methods: We analyzed data from a 20% beneficiary sample (approximately 120,000 continuously enrolled beneficiaries per year) for the Medi-Cal Fee-for-Service program during 1999 to 2000. AR medications available under Medi-Cal included three SGA medications (loratadine, fexofenadine, and cetirizine) and over 200 FGA products containing either diphenhydramine or chlorpheniramine or both. Because multiple medications were evaluated, a sample selection model was estimated using a two-stage multinomial logistic--variance components regression framework., Results: SGA medications have significantly lower total direct health-care treatment costs per patient than FGA medications with costs ranging from US 347 dollars to US 448 dollars less (P < 0.001), despite higher AR medication costs. Total drug expenditures were also not significantly different for patients using SGA or FGA medications despite SGA prescriptions averaging US 47 dollars higher than FGAs. Emergency department visits, inpatient admissions and physician office visits were also significantly lower for patients using SGA medications., Conclusions: Significant cost and utilization reductions were associated with all of the SGA medications relative to FGA drugs, despite their higher acquisition costs. If facing higher copayments for prescription AR drugs, many patients, particularly lower income patients, may choose cheaper over-the-counter (OTC) FGAs rather than SGAs. Our analysis finds this might lead to increased overall health-care treatment costs, unless Medicaid and health insurance plans subsidize OTC AR medications.

Background: There are no published studies that have compared the medical costs of patients with seasonal and perennial allergic rhinitis symptomatology., Objectives: The objectives of this study were to develop an algorithm for classifying patients into seasonal and perennial groups based on their patterns of allergy medication use and then compare the epidemiology and economics of the two groups., Methods: Data for the study were obtained from the 1996 to 1998 MarketScan databases containing linked inpatient, outpatient, and pharmaceutical claims for approximately 2 million covered lives annually. Patients were classified into seasonal allergic rhinitis (SAR) or perennial allergic rhinitis (PAR) groups based on their pattern of allergy medication use over the course of 1 year and then compared using descriptive methods., Results: Seventy-nine percent of the total study sample (80534 allergy patients) was classified as SAR and 21% as PAR. PAR patients were found to have higher mean levels of allergy-related outpatient payments (US dollars 568 vs. US dollars 471) and higher mean costs for second-generation antihistamines (US dollars 552 vs. US dollars 162). PAR patients also had higher levels of comorbidities (asthma, sinusitis, depression, and migraine), higher numbers of concomitant medications (multiple second-generation antihistamines, nasal steroids, other antihistamines, asthma medications, and ophthalmic decongestants), and more immunization encounters., Conclusions: Approximately 21% of allergic rhinitis patients have perennial symptoms as reflected in their patterns of medication use. Perennial patients have significantly higher allergy-related health-care costs and rates of comorbidities and greater use of concomitant medications. These distinct clinical and resource use profiles may have implications for therapy choices in the cost-effective management of perennial allergic rhinitis patients.

The present study extends prior work on the association between allergic rhinitis (AR) and common mental disorders by testing three related hypotheses: 1) that AR is associated with increased rates of depression and anxiety disorders in a large insured population, 2) comorbid AR, depression, and anxiety are associated with increased health and mental health expenditures, and 3) allergy treatment moderates the association between increased expenditures and comorbid AR, depression, and anxiety. Data are from MARKETSCAN, a large health care claims database of over 600,000 privately insured persons. Results indicate that AR is associated with higher rates of depression and anxiety disorder. Outpatient health care expenditures were increased by an average annual amount of $207 when AR and anxiety disorder were comorbid and $363 when AR and depression were comorbid. Finally, prescription treatment of AR moderated the increased expenditures associated with comorbidity.