The cost of treating allergic rhinitis
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Allergic rhinitis is a high-cost, high-prevalence disease. In the year 2000, over $6 billion was spent on prescription medications to treat this illness. Although it is not associated with severe morbidity and mortality, allergic rhinitis has a major effect on the quality of life of the more than 50 million Americans with this illness. Intranasal corticosteroids (INCS) and nonsedating antihistamines (NSAH) are the most common prescription medications for this disease. INCS are recognized as the most effective treatment regimen for chronic symptoms. NSAH are perceived as important in the treatment of patients with mild disease, or as add-on therapy to INCS. When the literature is reviewed, the INCS produce the greatest decrease in total nasal symptom scores, the largest effect size, when compared with NSAH. Both classes of medications produce similar effects on concurrent allergic conjunctivitis. Further recent studies indicate that the INCS are also superior when used on an as-needed basis, and that there is little clinical benefit from the addition of loratadine to intranasal fluticasone. INCS have lower average wholesale prices as a class than the NSAH. Since the INCS are the dominant medication in efficacy studies and cost less, cost-effectiveness studies always favor intranasal corticosteroids.
- Malone DC, Lawson KA, Smith DH, et al.: A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol 1997, 99:22–27. CrossRef
- Nathan RA, Meltzer EO, Selner JC, Storms W: The prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol 1997, 99:S808-S814. CrossRef
- Stempel DA, Thomas M: Treatment of allergic rhinitis: An evidence-based evaluation of nasal corticosteroids versus nonsedating antihistamines. Am J Man Care 1998, 4:89–96. This is a systematic review of controlled trials comparing NSAH with INCS. The results significantly favor the INCS for all symptom parameters.
- Storms W, Meltzer EO, Selner JC: The economic impact of allergic rhinitis. J Allergy Clin Immunol 1997, 99:S820-S824. CrossRef
- Dykewicz MS, Fineman S: Executive summary of joint task force practice parameters on diagnosis and management of rhinitis. Ann Allergy Asthma Immunol 1998, 81:463–468. A detailed presentation of important therapeutic questions and answers of the clinically relevant management issues in the treatment of allergic rhinitis.
- Blaiss MS: Cognitive, social, and economic costs of allergic rhinitis. Allergy Asthma Proc 2000, 21:7–13. CrossRef
- McMenamin P: Cost of hay fever in the United States in 1990. Ann Allergy 1994, 73:35–39.
- Ross RN: Hay fever: An expensive disease for American business. Am J Man Care 1996, 2:285–290.
- Meltzer EO, Nathan RA, Selner JC, Storms W: Quality of life and rhinitic symptoms: Results of a nationwide survey with the SF-36 and RQLQ questionnaires. J Allergy Clin Immunol 1997, 99:S815-S819. CrossRef
- Marick C: Proponents gather to discuss practicing evidence-based medicine. JAMA 1997, 278:531–532. CrossRef
- Spector SL: The placebo effect is nothing to sneeze at. J Allergy Clin Immunol 1992, 90:1042–1043. CrossRef
- Ferguson BJ: Cost-effective pharmacotherapy for allergic rhinitis. Otolaryngol Clin North Am 1998, 31:91–110. CrossRef
- Simons FE: The eternal triangle: benefit, risk, and cost of therapeutic agents. Ann Allergy Asthma Immunol 1996, 77:337–340.
- Buckley CE, Buchman E, Falliers CJ, et al.: Terfenadine treatment of fall hayfever. Ann Allergy 1988, 60:123–128.
- Bronsky EA, Dockhotrn RJ, Meltzer EO, et al.: Fluticasone propionate aqueous nasal spray compared with terfenadine tablets in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 1996, 97:915–921. CrossRef
- Stempel DA, Thomas M: Treatment of allergic rhinitis: an evidence-based evaluation of nasal corticosteroids versus nonsedating antihistamines. Am J Man Care 1998, 4:89–96.
- Weiner JM, Abramson MJ, Puy RM: Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998, 17:1624–1629. This is a meta-analysis of the comparative literature assessing the treatment of allergic rhinitis with either NSAH or INCS. Although the criteria for inclusion vary from the study by Stempel and Thomas, the results are similar.
- Wood SF: Oral antihistamine or nasal steroid in hay fever: a double-blind double-dummy study of once daily oral astemizole vs twice daily beclomethasone dipropionate. Clin Allergy 1986, 16:195–201. CrossRef
- Corren J: Intranasal corticosteroids for allergic rhinitis: how do the different agents compare? J Allergy Clin Immunol 1999, 104:144–149. CrossRef
- Derby A, Maier WC: Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunol 2000, 105:9120û916. CrossRef
- Ratner PH, van Baval JH, Martin BG, et al.: A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, for the treatment of seasonal allergic rhinitis. J Fam Pract 1998, 47:118–125. This study addresses the clinical and economical question of whether there is a benefit from the addition of loratadine to fluticasone in the treatment of allergic rhinitis. This study makes the argument that no further clinical benefit is gained from the addition of this nonsedating antihistamine.
- Jen A, Baroody F, deTineo M, et al.: As-needed use of fluticasone propionate nasal spray reduces symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 2000, 105:732–738. CrossRef
- Kaszuba SM, Baroody FM, deTineo M: Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Arch Intern Med 2001, 161:2581–2587. This recent study compares treatment options for patients with mild allergic rhinitis and reflects how patients frequently treat their allergic rhinitis. In this study, as-needed therapy with fluticasone was clinically and significantly superior to as-needed treatment with loratadine. CrossRef
- Meltzer EO, Malmstrom K, Lu S, et al.: Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: A randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 2000, 105:917–922. CrossRef
- Pullerits T, Praks L, Skoogh B-E, et al.: Randomized placebocontrolled study comparing a leukotriene receptor antagonist and a nasal glucocorticoid in seasonal allergic rhinitis. Am J Respir Crit Care Med 1999, 159:1814–1818.
- van Cauwenberge P, Juniper EF: Comparison of the efficacy, safety, and quality of life provided by fexofenadine hydrochloride 120mg, loratadine 10mg and placebo administered once daily for the treatment of seasonal allergic rhinitis. Clin Exp Allergy 2000, 30:891–899. CrossRef
- Howarth PH, Stern MA, Roi L, et al.: Double-blind, placebo-controlled study comparing the efficacy and safety of fexofenadine hydrochloride (120 and 180 mg once daily) and cetirizine in seasonal allergic rhinitis. J Allergy Clin Immunol 1999, 104:927–933. CrossRef
- AdelrothE, Rak S, Haahtela T, et al.: Recombinant humanized mAb-E25, an anti-IgE mAb, in birch pollen induced seasonal allergic rhinitis. J Allergy Clin Immunol 2000, 106:253–259. CrossRef
- Casale T, Condemi J, Miller SD, et al.: rhuMab-E25 in the treatment of seasonal allergic rhinitis [abstract]. Ann Allergy Asthma Immunol 1999, 82:75. CrossRef
- The cost of treating allergic rhinitis
Current Allergy and Asthma Reports
Volume 2, Issue 3 , pp 223-230
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