The cost-effectiveness of treatment with desloratadine in patients with persistent allergic rhinitis

Abstract

Objectives:

A new classification of persistent allergic rhinitis (PER) has been developed by the ARIA working group. Although the burden of AR is significant, treatment itself is also costly. It is unclear if treatment based on the new definition of PER is cost-effective.

Methods:

The current study simulated the cost-effectiveness of desloratadine compared to placebo in the treatment of PER from the French societal perspective. Decision analysis was used to model the costs, effectiveness and cost-effectiveness over 12 months. Costs included medical expenditures (physician visits and prescription drugs) attributable to PER and related comorbidities and lost productivity due to absenteeism and presenteeism. Prices, tariffs and national wages were estimated from French national sources. Measures of effectiveness included: symptom-based visual analogue scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Total 5 Symptoms Score (T5SS), categorical improvement in therapeutic response, interference with activities of daily living (ADL) and sleep outcomes. Mild or symptom-free days and ‘responders’ were also captured as outcomes. Univariate and second-order multivariate probabilistic sensitivity analyses were conducted.

Results:

Treatment with desloratadine dominated placebo (cost less and resulted in greater effectiveness) for all measures of effectiveness. Of the individuals taking desloratadine 46.8% were classified as ‘responders’ vs. 34.8% for placebo (p = 0.0012). Individuals taking desloratadine experienced mild/no symptoms for 57.6% of study days vs. 36.5% for placebo (p = 0.002). The expected annual cost of treatment with desloratadine (€1819) was less than placebo (€2618). Lost productivity was the most significant contributor to total cost. Results of the 10,000 Monte Carlo simulations showed that treatment was cost-saving in 99.6% of simulations.

Conclusions:

Treatment of PER with desloratadine resulted in improved effectiveness and significant savings. While the cost of drug treatment is greater than that of no treatment, the downstream costs associated with not treating PER significantly outweigh the cost of treatment. Key limitations include the comparison of desloratadine to placebo and the sources of cost and effectiveness measures. Future studies should examine the cost-effectiveness of all available treatments for PER. In addition, many utilization, productivity and effectiveness measures were taken from clinical trials and may not accurately reflect ‘real world’ treatment patterns and outcomes.

Key words::

• Cost–benefit analysis
• Cost-effectiveness analysis
• Desloratadine
• Histamine H1 antagonists
• non-sedating
• Rhinitis
• allergic
• perennial

Transparency

Declaration of funding

Funding was provided by a grant from Merck.

Declaration of financial/other relationships

P.N., R.L., and T.S. are employees of Merck. P.S. has served as a consultant to Merck.

Peer reviewers may receive honoraria from CMRO for their review work. The peer reviewers have disclosed no relevant financial relationships.

Acknowledgments

The results of this study were presented as a podium presentation at the XXI World Allergy Congress, Buenos Aires, Argentina, December 9 2009.