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
| العنوان: | 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 |
|---|---|
| المؤلفون: | Elissa M. Abrams, John Oppenheimer, Matthew Greenhawt, David R. Stukus, Marcus Shaker, Giselle Mosnaim |
| المصدر: | The Journal of Allergy and Clinical Immunology: In Practice The Journal of Allergy and Clinical Immunology. in Practice |
| بيانات النشر: | Elsevier BV, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Cost-Benefit Analysis, Health Status, Self Administration, allergy immunotherapy, American College of Allergy, Asthma and Immunology, ACAAI, venom immunotherapy, VIT, 0302 clinical medicine, Health care, Pandemic, health outcomes, Medicine, Immunology and Allergy, Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, 030212 general & internal medicine, emergency department, ED, Child, systemic reactions, SR, health care economics and organizations, SCIT, subcutaneous immunotherapy, allergic rhinitis, AR, coronavirus disease 2019, COVID-19, quality adjusted life years, cost-effectiveness analysis, willingness to pay, WTP, quality adjusted life years, QALY, incremental cost-effectiveness ratio, ICER, Cost-effectiveness analysis, Middle Aged, simulation, Markov Chains, Child, Preschool, epinephrine auto-injectors, systemic reaction to immunotherapy, Coronavirus Infections, Incremental cost-effectiveness ratio, Adult, Allergen immunotherapy, medicine.medical_specialty, home venom immunotherapy, HOMVIT, Adolescent, Pneumonia, Viral, home allergen immunotherapy self-administration, HITSA, Article, Betacoronavirus, Young Adult, 03 medical and health sciences, fatality, Net Monetary Benefit, NMB, anaphylaxis, and Canadian Society of Allergy and Clinical Immunology, CSACI, Humans, Epinephrine autoinjector, epinephrine, Intensive care medicine, Pandemics, allergic rhinitis, American Academy of Allergy, Asthma and Immunology, AAAAI, SARS-CoV-2, business.industry, systemic reactions to immunotherapy, SRIT, COVID-19, Allergen immunotherapy, AIT, allergy, Health Literacy, Quality-adjusted life year, World Health Organization, WHO, 030228 respiratory system, venom immunotherapy, Desensitization, Immunologic, economic outcomes, Relative risk, epinephrine auto-injector, EAI, business |
| الوصف: | Background Allergen immunotherapy is safe and effective but is typically administered under strict clinic observation to mitigate risk of a systemic reaction to immunotherapy (SRIT). However, in the setting of the global COVID-19 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 allergen immunotherapy in a shelter-in-place or other scenarios of unforeseen reduction in non-essential medical services. Methods Markov modeling was used to compare in-office clinic allergen immunotherapy in selected patients using cohort analysis and microsimulation from the societal and healthcare perspectives. Results Assuming similar SRIT rates, HITSA was found to be a cost-effective option with an incremental cost-effectiveness ratio (ICER) of $44,554/QALY (quality adjusted life year) when considering both incremental epinephrine autoinjector (EAI) costs and COVID-19 risks. Excluding EAI costs, HISTA dominated other options. However, outside of pandemic considerations, HITSA was not cost effective (ICER $198,877,286) at annual EAI 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 COVID-19. Conclusion 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. Highlights What is already known on this topic: Allergy/immunology clinical practices are not immune to natural disasters or global pandemics, which may force service reduction or abrupt changes in practice. What does this article add to our knowledge: Home allergen immunotherapy can be cost-effective in highly selected patients under pandemic shelter-in-place conditions provided home SRIT rates remain stable; however, careful patient selection is critical. How does this study impact current management guidelines: This cost-effectiveness analysis demonstrates potential feasibility of allergen immunotherapy for appropriately screened patients. This may help inform decision-making regarding how to provide this valuable allergy service in a current or future natural disaster or pandemic. |
| اللغة: | English |
| تدمد: | 2213-2198 |
| DOI: | 10.1016/j.jaip.2020.05.007 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::414b10a3953e6e546c309a63e8c439e1 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....414b10a3953e6e546c309a63e8c439e1 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 22132198 |
|---|---|
| DOI: | 10.1016/j.jaip.2020.05.007 |