Healthcare costs for allergic rhinitis patients on allergy immunotherapy: a retrospective observational study

Abstract

Objective: Subcutaneous immunotherapy (SCIT) for allergic rhinitis (AR) has been shown to control symptoms for up to several years following treatment discontinuation, but the effect of SCIT on healthcare costs for commercially insured patients is unknown. The objective of this study was to compare healthcare costs and resource utilization for patients with AR who received SCIT compared with those who discontinued SCIT shortly after initiation.

Methods: This retrospective cohort study evaluated medical and pharmacy claims from the Optum Research Database from January 2009 through February 2014 for adults and pediatric patients with >7 (continuers) vs. ≤7 (discontinuers) injection visits for SCIT within 60 days of initiation.

Results: After 1:1 propensity score matching, each cohort included 6710 patients. Continuers were less likely than discontinuers to use oral corticosteroids (27.7% vs. 29.6%, p = .018), or to have ≥1 respiratory-related emergency room visit (5.4% vs. 6.5%, p = .008) and ≥1 inpatient stay (1.1% vs. 1.7%; p = .002). Continuers were more likely than discontinuers to have ≥1 AR-related office (98.8% vs. 94.6%, p < .001) or outpatient visit (2.4% vs. 1.7%, p = .002). Continuers had greater mean total AR-related costs than discontinuers ($1918 vs. $646, p < .001). Unadjusted mean total respiratory-related costs were lower for continuers than discontinuers, although the difference was not statistically significant ($1589 vs. $1785, p = .077); when adjusted with a generalized linear model, these costs were significantly lower among continuers (p < .001).

Conclusions: Continued SCIT use is associated with decreased emergency room visits and inpatient stays, decreased oral corticosteroid use, and lower respiratory-related costs, compared with early discontinuation.

Keywords:

• Subcutaneous immunotherapy
• allergy immunotherapy
• allergic rhinitis
• healthcare costs
• healthcare utilization

Transparency

Declaration of funding

This work was funded by Merck, which participated in the design of the study; in the development of the analytic plan and interpretation of the data; in the writing of the report; and in the decision to submit the manuscript for publication.

Author contributions: F.A.R., J.M., M.R., R.N. and R.H. participated in the conception and design of the study. F.A.R., J.M., C.B.P. and R.H. helped analyze and interpret the data. All authors participated in critical revision of the manuscript, approved the final version for publication, and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

F.A.R. has disclosed that she is an employee and shareholder of Merck. M.R. has disclosed that he was a fellow at Merck when the research was conducted. J.M., C.B.P., and R.H. have disclosed that they are employees of Optum, which was contracted and paid by Merck to execute this study (i.e., perform data extraction, programming, and analysis) and develop this manuscript. R.N. has disclosed that he received grant/research support from Merck and served on Merck speakers bureaus.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Medical writing and editorial assistance were provided by Sarah Thornburg MS of Arbor Communications Inc. (Ann Arbor, MI, USA) and Yvette Edmonds PhD, an employee of Optum (Eden Prairie, MN, USA). Yiyu Fang, also an employee of Optum, created the analytical dataset.