Abstract
Background: Allergen immunotherapy has proved effective in the treatment of various allergies, but whether the clinical benefits outweigh the economic costs has been little evaluated.
Objective: To explore the economic consequences of immunotherapy in asthma, rhinitis and dermatitis.
Methods: Descriptive study. Patients with at least 18 months’ follow-up were selected, whose medical history allowed evaluation of drugs received, manner of use, check-ups, treatment changes, reasons for these, and so on. Patients were classified according to whether they received drug treatment + immunotherapy (active group) or drug therapy alone (control group).
Results: 1848 patients were included: 648 in the active group and 1200 in the control. Immunotherapy increased the cost of treatment during the first few months, but after 9 to 12 months drug treatment decreased significantly compared to the control group. In patients with asthma or various diseases, immunotherapy reduced costs of treatment (p < 0.05). The active group saw fewer relapses at 18 months (p < 0.05).
Conclusion: Allergen immunotherapy allows the sustained reduction in drug treatment, with medium-term financial savings for the patient and the health system.
References
Sawicki GS, Vilk Y, Schatz M, Kleinman K, Abrams A, Madden J. Uncontrolled asthma in a commercially insured population from 2002 to 2007: trends, predictors, and costs. J Asthma. 2010;47(5):574-80. doi: 10.3109/0277090100379284
Möller C, Dreborg S, Ferdousi HA, Halken S, Høst A, Jacobsen L, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol. 2002;109(2):251-6. doi: 10.1067/mai.2002.121317
Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Høst A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT Study. Allergy. 2007;62(8):943-8. doi: 10.1111/j.1398-9995.2007.01451.x
Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010(8):CD001186.
Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. 1998;102(4 Pt 1):558-62. doi: 10.1002/14651858.
Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011;127(3):587-93.e1-22. doi: 10.1016/j. jaci.2011.01.038.
Fernández-Caldas E, Baena-Cagnani CE, López M, Patiño C, Neffen HE, Sánchez-Medina M, et al. Cutaneous sensitivity to six mite species in asthmatic patients from five Latin American countries. J Investig Allergol Clin Immunol. 1993;3(5):245-9.
Sánchez J, Diez S, Cardona R. Sensibilización a aeroalergenos en pacientes alérgicos de Medellín, Colombia. Rev Alergia Mex. 2012;59(3):139-47.
Sánchez J, Diez S, Cardona R. Frecuencia de sensibilización a animales en un área tropical. Rev Alerg Mex. 2014;61(2):81-9.
Sánchez J, Restrepo M, Diez S, Cardona R. Comparación del efecto clínico de la inmunoterapia en pacientes con asma alérgica según la edad y el patrón de sensibilización. Alerg Asma Inmunol Pediatr. 2012;21(3):77-85.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi:10.1016/0021- 9681(87)90171-8
van Strien RT, Koopman LP, Kerkhof M, Spithoven J, de Jongste JC, Gerritsen J, et al. Mite and pet allergen levels in homes of children born to allergic and nonallergic parents: the PIAMA Study. Environ Health Perspect. 2002;110(11):A693-8.
Caudri D, Wijga AH, Smit HA, Koppelman GH, Kerkhof M, Hoekstra MO, et al. Asthma symptoms and medication in the PIAMA birth cohort: evidence for under and overtreatment. Pediatr Allergy Immunol. 2011;22(7):652-9. doi: 10.1111/j.1399-3038.2011.01193.x
Sánchez-Caraballo J, Cardona-Villa R. Clinical and Immunological changes of Immunotherapy in patients with atopic dermatitis: randomized controlled trial. ISRN Allergy. 2012:1-9. doi: 10.5402/2012/183983
Jutel M, Akdis CA. Immunological mechanisms of allergen-specific immunotherapy. Allergy. 2011;66(6):725-32. doi: 10.1111/j.1398-9995.2011.02589.x
Scadding G, Durham SR. Mechanisms of sublingual immunotherapy. Immunol Allergy Clin North Am. 2011;31(2):191-209, viii. doi: 10.1016/j.iac.2011.02.005
Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1-55. doi: 10.1016/j.jaci.2010.09.034
Dennis RJ, Caraballo L, García E, Rojas MX, Rondon MA, Pérez A, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med. 2012;12:17. doi: 10.1186/1471-2466-12-17
Kurukulaaratchy RJ, Karmaus W, Arshad SH. Sex and atopy influences on the natural history of rhinitis. Curr Opin Allergy Clin Immunol. 2012;12(1):7-12. doi: 10.1097/ACI.0b013e32834ecc4e
Vergara C, Caraballo L. Asthma mortality in Colombia. Ann Allergy Asthma Immunol. 1998;80(1):55-60. doi:10.1016/S1081-1206(10)62940-7
Neffen H, Baena-Cagnani CE, Malka S, Solé D, Sepúlveda R, Caraballo L, et al. Asthma mortality in Latin America. J Investig Allergol Clin Immunol. 1997;7(4):249-53.
Rodríguez-Martínez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Cost-utility analysis of the inhaled steroids available in a developing country for the management of pediatric patients with persistent asthma. J Asthma. 2013;50(4):410-8. doi: 10.3109/02770903.2013.767909
Hankin CS, Cox L, Bronstone A, Wang Z. Allergy immunotherapy: reduced health care costs in adults and children with allergic rhinitis. J Allergy Clin Immunol. 2013;131(4):1084-91. doi: 10.1016/j. jaci.2012.12.662
Canonica GW, Passalacqua G. Disease-modifying effect and economic implications of sublingual immunotherapy. J Allergy Clin Immunol. 2011;127(1):44-5. doi: 10.1016/j.jaci.2010.09.037
Bielory L, Mongia A. Current opinion of immunotherapy for ocular allergy. Curr Opin Allergy Clin Immunol. 2002;2(5):447-52.Lin SY, Erekosima N, Kim JM, Ramanathan M, Suárez-Cuervo C, Chelladurai Y, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013;309(12):1278-88. doi: 10.1001/jama.2013.204
Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428-33. doi: 10.1016/j.jaci.2012.10.041
Bae JM, Choi YY, Park CO, Chung KY, Lee KH. Efficacy of allergen-specific immunotherapy for atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2013; 132(1):110-7. doi: 10.1016/j.jaci.2013.02.044
Sánchez J, Páez B, Macías A, Olmos C, de Falco A. Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology. Rev Alerg Mex. 2014;61(3):178-211.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2016 Revista Alergia México