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2020 ; 8
(7
): 2310-2321.e4
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Health and Economic Outcomes of Home Maintenance Allergen Immunotherapy in Select
Patients with High Health Literacy during the COVID-19 Pandemic: A
Cost-Effectiveness Analysis During Exceptional Times
#MMPMID32417446
Shaker MS
; Mosnaim G
; Oppenheimer J
; Stukus D
; Abrams EM
; Greenhawt M
J Allergy Clin Immunol Pract
2020[Jul]; 8
(7
): 2310-2321.e4
PMID32417446
show ga
BACKGROUND: Allergen immunotherapy (AIT) is safe and effective but is typically
administered under strict clinic observation to mitigate the risk of a systemic
reaction to immunotherapy (SRIT). However, in the setting of the global
coronavirus disease 2019 pandemic, alternative care models should be explored.
OBJECTIVE: To evaluate the cost-effectiveness of home immunotherapy
self-administration (HITSA) in a highly idealized circumstance for provision of
maintenance AIT in a shelter-in-place or other scenarios of unforeseen reduction
in nonessential medical services. METHODS: Markov modeling was used to compare
in-office clinic AIT in selected patients using cohort analysis and
microsimulation from the societal and health care perspectives. RESULTS: Assuming
similar SRIT rates, HITSA was found to be a cost-effective option with an
incremental cost-effectiveness ratio of $44,554/quality-adjusted life-year when
considering both incremental epinephrine autoinjector costs and coronavirus
disease 2019 risks. Excluding epinephrine autoinjector costs, HISTA dominated
other options. However, outside of pandemic considerations, HITSA was not
cost-effective (incremental cost-effectiveness ratio, $198,877,286) at annual
epinephrine autoinjector costs above $287. As the incremental HITSA SRIT rate
increased above 15%, clinic AIT was the most cost-effective strategy. Excluding
both pandemic risks and risk of motor vehicle accident fatality from round-trip
clinic transit, clinic AIT dominated other strategies. Clinic AIT was the more
cost-effective option at very high fatality relative risk for HITSA or at very
low annual risk of contracting coronavirus disease 2019. CONCLUSIONS: Under
idealized assumptions HITSA can be a safe and cost-effective option during a
global pandemic in appropriately selected patients provided home rates of SRIT
remain stable.