Allergy Immunotherapy (AIT)

Reduced health care costs in adults and children with allergic rhinitis.

Cheryl S. Hankin, PhD, Linda Cox, MD, Amy Bronstone, PhD, Zhaohui Wang, MS.

Received 9 December 2011; received in revised form 7 December 2012; accepted 10 December 2012. published online 01 February 2013.

Background

Research demonstrates significant health care cost savings conferred by allergen-specific immunotherapy (AIT) to US children with allergic rhinitis (AR).

Objective

We sought to examine whether AIT-related cost benefits conferred to US children with AR similarly extend to adults.

Methods

A retrospective (1997-2009) Florida Medicaid claims analysis compared mean 18-month health care costs of patients with newly diagnosed AR who received de novo AIT and were continuously enrolled for 18 months or more versus matched control subjects not receiving AIT. Analyses were conducted for the total sample and separately for adults (age ≥18 years) and children (age <18 years).

Results

Matched were 4,967 patients receiving AIT (1,319 adults and 3,648 children) and 19,278 control subjects (4,815 adults and 14,463 children). AIT-treated enrollees incurred 38% ($6,637 vs $10,644, P < .0001) lower mean 18-month total health care costs than matched control subjects, with significant savings observed within 3 months of AIT initiation. Compared with control subjects, significantly lower 18-month mean health care costs were demonstrated overall (38%; $6,637 for patients receiving AIT vs $10,644 for control subjects, P < .0001), and for both AIT-treated adults (30%; $10,457 AIT vs $14,854 controls, P < .0001) and children (42%; $5,253 AIT vs $9,118 controls, P < .0001). The magnitude of 18-month health care cost savings realized by AIT-treated adults and children did not significantly differ ($4,397 vs $3,965, P = .435).

Conclusions

Patients with newly diagnosed AR initiating AIT incurred significantly lower health care costs than matched control subjects beginning 3 months after AIT initiation and continuing throughout the 18-month follow-up period. The significant cost benefits achieved by children with AR diagnoses who initiated AIT were also observed for adults with AR diagnoses who initiated AIT.

Key words: Allergic rhinitis, allergy immunotherapy, allergy immunotherapy, costs, health care use, Medicaid, matched cohort, retrospective, administrative claims

Abbreviations used: AIT, Allergen-specific immunotherapy, AR, Allergic rhinitis, CCI, Charlson Comorbidity Index, GEE, Generalized estimating equations, ICD-9, International Classification of Disease, ninth edition