, Volume 22, Issue 6, pp 345–361 | Cite as

The Economic Burden of Allergic Rhinitis

A Critical Evaluation of the Literature
  • Shelby D. Reed
  • Todd A. Lee
  • Douglas C. McCrory
Review Article


Although a large number of economic analyses of allergic rhinitis have been published, there are relatively few empirically based studies, particularly outside the US. The majority of these analyses can be classified as burden-of-illness studies. Most estimates of the annual cost of allergic rhinitis range from $US2–5 billion (2003 values). The wide range of estimates can be attributed to differences in identifying patients with allergic rhinitis, differences in cost assignment, limitations associated with available data and difficulties in assigning indirect costs (associated with reduced productivity) of allergic rhinitis.

Approximately one-third of burden-of-illness studies include direct and indirect costs of allergic rhinitis, about one-third focus on direct costs only, and the remaining one-third focus exclusively on indirect costs due to reduced productivity. Indirect costs attributable to allergic rhinitis were higher in studies only estimating indirect costs ($US5.5–9.7 billion) than in those estimating both direct and indirect costs ($US1.7–4.3 billion).

Although there are many economic evaluations of allergic rhinitis treatments in the published medical literature, very few represent formal cost-effectiveness evaluations that compare the incremental costs and benefits of alternative treatment strategies. Those that are incremental cost-effectiveness analyses have several limitations, including small samples, short study periods and the lack of a standardized measure of effectiveness.

To date, the medical literature is lacking a comprehensive economic evaluation of general treatment strategies for allergic rhinitis. In undertaking such an analysis, serious consideration must be given to the study population of interest, the choice of appropriate comparators, the perspective from which the analysis is conducted, the target audience, the changing healthcare marketplace and the selection of a measure of effectiveness that incorporates both positive and negative aspects of treatments for allergic rhinitis.

Future work would benefit from the development of a consensus on a summary measure of effectiveness that could be used in cost-effectiveness analyses of therapies for allergic rhinitis as well as additional empirical work to measure the association between severity of disease and its impact on worker productivity.


Indirect Cost Allergic Rhinitis Fluticasone Propionate Terfenadine Fexofenadine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This review was undertaken by the Duke University Evidence-Based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ) [contract no. 290-97-0014], Rockville, MD, USA.

This article is based on research conducted by Duke University under contract to the AHRQ (contract no. 290-97-0014). The authors are solely responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the AHRQ, the US Department of Health and Human Services or the Department of Veterans Affairs. The authors have no conflicts of interest directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Shelby D. Reed
    • 1
  • Todd A. Lee
    • 2
    • 3
  • Douglas C. McCrory
    • 4
    • 5
  1. 1.Center for Clinical and Genetic Economics, Duke Clinical Research InstituteDuke University Medical CenterDurhamUSA
  2. 2.Midwest Center for Health Services and Policy ResearchHines VA HospitalHinesUSA
  3. 3.Center for Healthcare Studies, Division of General Internal Medicine, and the Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Center for Health Policy Research and EducationDuke University Medical CenterDurhamUSA
  5. 5.Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamUSA

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