Healthcare Costs Slashed by One Third When Allergic Children Receive Immunotherapy

Nancy Fowler Larson

January 12, 2010

January 12, 2010 — Use of immunotherapy in children with allergic rhinitis (AR) decreases their healthcare costs by one third and prescription costs were reduced by 16%, according to a study published in the January issue of the Annals of Allergy & Asthma Immunology.

"In addition to its long-term sustained efficacy, immunotherapy is the only treatment proved to alter the course of allergic disease as demonstrated by its association with significant reductions in the likelihood that children with AR will develop asthma and new sensitizations to aeroallergens," write Cheryl Hankin, PhD, from BioMedEcon LLC, Moss Beach, California, and colleagues. "Given these important benefits, immunotherapy is likely to be a cost-effective option for the management of AR."

AR ranks third in chronic diseases in children in the United States and is responsible for $2.3 million in healthcare costs for children younger than 12 years, as well as 2 million days of school absences.

This retrospective, matched-cohort study analyzed the records of Florida Medicaid recipients with claims paid during a 10-year period beginning in July 1997. All subjects were younger than 18 years and had recently diagnosed AR, after which they received at least 2 rounds of immunotherapy. Those with fewer than 18 months of follow-up data were excluded.

After this elimination, 2771 immunotherapy-treated patients remained. They were matched with others in a control group of 11,010 patients who had not received immunotherapy.

Results showed that the 18-month median total healthcare costs for patients receiving immunotherapy were notably less ($3247 vs $4872). In addition, after subtracting expenses for immunotherapy, the outpatient costs of the immunotherapy group were lower ($1107 vs $2626), and their pharmacy bills were also less ($1108 vs $1316) than those of the matched control patients (P < .001 for all). These differences began to emerge after 3 months of immunotherapy and increased throughout the study.

The reduced costs persisted after matching groups by variables including sex, race/ethnicity, and age at first AR diagnosis, as well as by comorbidities such as asthma, conjunctivitis, and atopic dermatitis. Following those adjustments, patients treated with allergy immunotherapy each had 33% ($1625) lower healthcare expenses. Their outpatient costs were reduced by 29% ($765) to 58% ($1519), and the amount of money spent on prescriptions was reduced by 16% ($208; P < .001 for all) after immunotherapy initiation. Again, these significant differences were still evident after 18 months.

"These findings confirm and strengthen those of earlier studies," the authors write. "In a previous study, we found that the cost of immunotherapy was offset by the cost savings accrued during the 6 months after immunotherapy completion, but we did not find additional cost savings."

The authors noted 4 limitations to their study:

  • Subjects' treatment adherence to medications and avoidance of allergens were not determined.

  • The study's retrospective, observational character prevented findings for causality.

  • Because patients were Medicaid recipients, findings may not translate to privately insured individuals.

  • The 18-month follow-up period was limited to the relatively few subjects who underwent immunotherapy and also maintained enrollment in the study (the original pool was 2985 eligible vaccinated patients and 176,202 eligible control participants).

The authors touted their findings as having far-reaching and varied consequences.

"This is great news, not only for families who will experience fewer out-of-pocket expenses for allergy medications, but also for the ever increasing national health care crisis," said Linda Cox, MD, study coauthor and former chair of the Immunotherapy and Diagnostic Committee of the American College of Allergy, Asthma & Immunology , in a news release. "Because of the serious medical and economic consequences of childhood [AR], early diagnosis and aggressive treatment need to be our priority."

Dr. Hankin is a consultant for Greer Laboratories, which supported this study. The study authors have disclosed no other relevant financial relationships.

Ann Allergy Asthma Immunol. 2010;104:79-85.

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