Cost-effectiveness of grass pollen subcutaneous immunotherapy (SCIT) compared to sublingual immunotherapy (SLIT) and symptomatic treatment in Austria, Spain, and Switzerland

Figures & data

Figure 1. Basic structure of the underlying Markov model (all patients are at risk of death. This is not shown, in order to simplify representation). Abbreviations. AA, allergic asthma; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy.

Table 1. European SIT discontinuation rates.

Source	Data origin	n	Country	Year 1	Year 2	Year 3
SLIT
Senna et al.^14 (2010)	Rx data	*	I	47%	18%	40%
Sieber et al.^15 (2011)	Rx data	112	D	29%	28%	18%‡
Andreasen et al.^17 (2012)	Rx data	636	SE	28%	24%#	7%
Kiel et al.^16 (2013)	Rx data	3,690	NL	62%	53%	61%
Egert-Schmidt et al.^37 (2014)	Market data	706	D	47%	51%	38%
Lemberg et al.^38 (2017)	PMS data	123	D	37%	3%	0%
Mean				42%	29%	27%
SCIT
Sieber et al.^15 (2011)	Rx data	602	D	41%	34%	33%‡
Andreasen et al.^17 (2012)	Rx data	354	SE	27%	22%	7%
Kiel et al.^16 (2013)	Rx data	2,796	NL	20%	49%	44%
Egert-Schmidt et al.^37 (2014)	Rx data	85,241	D	0%	52%	44%
Lemberg et al.^38 (2017)	Market data	207	D	21%	15%	0%
Mean				22%	34%	26%

Discontinuation rates of follow-up years were based on remaining patients at the end of the prior period.

If discontinuation was not reported, rates either have been calculated based on provided adherence data or derived from published survival functions.

* not specified—sales data from two major companies in Italy from 2006–2009.

# Year 2 approximated via log-function.

‡ Year 3 approximated via log-function.

Abbreviations. D, Germany; I, Italy; NL, The Netherlands; SE, Sweden; Rx, prescription; PMS, patient management system.

Table 2. Model calculation input data.

	Austria		Spain	Switzerland Conversion rate €/CHF	Min–max variation in sensitivity analyses
Model assumptions
Mortality rate for allergic asthma p.a.^11	0.069%		0.069%	0.069%
Background mortality rate p.a.^47	0.048%		0.035%	0.035%	±30%
Dropout rate for SCIT Allergovit^14–17^,^37^,^38	Year 1	22%	22%	22%	±30%
	Year 2	34%	34%	34%	±30%
	Year 3	26%	26%	26%	±30%
Dropout rate for SLIT Oralair^14–17^,^37^,^38	Year 1	42%	42%	42%	±30%
	Year 2	29%	29%	29%	±30%
	Year 2	27%	27%	27%	±30%
Asthma incidence p.a.^11	0.46%		0.46%	0.46%	±30%
Relative risk reduction in asthma incidence with SIT^11	50.5%		50.5%	50.5%	±30%
Pollen season duration (months)^18–20	4.5		4.5	4.5	±30%
Cost and resource assumptions
Costs for SCIT with Allergovit over 3 years	1,098.90€		645.12€	1,215.56€	±10%
Costs for SLIT with Oralair over 3 years	2,813.10€		1,523.47€	2,805.42€	±10%
Costs for loratadine per season^48^,^49^,^50	SIT	6.14€	4.76€	22.45€	±10%
	ST	9.01€	6.99€	32.93€	±10%
Costs for budesonide per season^48^,^49^,^50	SIT	2.39€	1.10€	2.46€	±10%
	ST	4.18€	1.92€	4.30€	±10%
Costs per contact with a medical specialist^51–55	18.82€		79.90€	17.51€	±10%
Costs per SCIT injection^51–55	2.71€		13.89€	22.26€	±10%
Diagnostic work-up^51–55	29.49€		120.00€	47.87€	±10%
Costs attributable to allergic asthma p.a.^5^,^56^,^57	753.00€		1,355.00€	1,779.00€	±50%
Number of annual physician contacts for SCIT with Allergovit^21^,^24	7		3	7	±30%
Number of injections p.a. for SCIT with Allergovit^21	7		7	7	±30%
Discount rate p.a.	3%		3%	3%	±30%

Abbreviations. SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy; ST, symptomatic treatment.

Table 3. Per-patient costs over 9 years (discounted) according to treatment type, taking into account all patients in a treatment arm (including those that dropped out from SIT).

Type of cost	Allergovit	Oralair	Symptomatic treatment
Austria
SIT	710€	1,506€	–
Symptomatic treatment	87€	91€	106€
Asthma costs	32€	36€	49€
Visits to a medical specialist	472€	350€	286€
Injections	37€	–	–
Allergy diagnostic work-up	29€	29€	–
Total costs per patient	1,368€	2,012€	441€
Spain
SIT	417€	816€	–
Symptomatic treatment	59€	62€	71€
Asthma costs	57€	65€	89€
Visits to a medical specialist	1,386€	1,485€	1,216€
Injections	189€	–	–
Allergy diagnostic work-up	120€	120€	–
Total costs per patient	2,229€	2,547€	1,376€
Switzerland*
SIT	786€	1,502€	–
Symptomatic treatment	250€	259€	298€
Asthma costs	75€	85€	116€
Visits to a medical specialist	440€	326€	266€
Injections	302€	–	–
Allergy diagnostic work-up	48€	48€	–
Total costs per patient	1,901€	2,220€	681€

* Conversion rate CHF/€: 0.93.

Abbreviation. SIT, specific immunotherapy.

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