| 1. Is
Rhinocort® a cost-effective treatment for rhinitis? |
The
direct costs associated with allergic rhinitis in the USA have
increased substantially, with estimates in 1990 at US $1.2 billion
(McMenamin 1994) rising to US $4.5 billion in 1997 (Mackowiak 1997).
Indirect costs of allergic rhinitis in the USA are also high with
estimates ranging from US $2.4 to 4.6 billion in 1995 (Crystal-Peters
et al 2000).
A
treatment efficiency assessment involving reviews of the literature
and average US wholesale prices was completed by Lee and colleague
(2004) to determine the most cost-effective treatment for allergic
rhinitis. Intranasal corticosteroids were shown to be the most
cost-effective treatment for allergic rhinitis and of these, based on
US data, Rhinocort® Aqua™ represents the most efficient
treatment choice (Figure 1) (Lee et al 2004).
Figure
1. Differences in effectiveness and costs of intranasal
corticosteroids, non-sedating antihistamines and a leukotriene
receptor antagonist (Lee et al 2004)
A recent analysis by Reissman and
colleagues (2004), again based on 2002 US data, demonstrated that
Rhinocort® Aqua™ offers a greater number of treatment days
per prescription than other marketed intranasal steroids based on
once-daily starting doses (Figure 2). In addition, Rhinocort®
Aqua™ has a lower cost per day of treatment at US $1.54
compared with the other three major brands of intranasal
corticosteroid: fluticasone propionate (US $1.88), mometasone furoate
(US $1.80) and triamcinolone acetonide (US $1.97) (Figure 3; Reissman
et al 2004).
Figure
2. Mean days of treatment supply per prescription (one bottle)
(Reissman et al 2004)
Figure 3. Mean cost per day
of treatment (Reissman et al 2004)
The
results of this analysis are supported by two other studies on the
cost-effectiveness of Rhinocort® (Ståhl et al 2000; Roberts
et al 2003). The first was a retrospective, randomised,
parallel-group study in 314 patients with perennial allergic rhinitis
(Ståhl et al 2000). This study demonstrated that Rhinocort®
Aqua™ 256 µg/day was more cost-effective than fluticasone
propionate 200 µg/day (Figure 4) (Ståhl et al 2000).
Figure
4. Total cost of 12 months’ treatment with budesonide 256
µg/day and fluticasone 200 µg/day in 314 patients with
perennial allergic rhinitis (Ståhl et al 2000)
The
second was a 2-year retrospective study in 3492 patients with
allergic rhinitis who had not received either intranasal
corticosteroids or antihistamine treatment for 12 months (Roberts et
al 2003). This study demonstrated that patients initially treated
with Rhinocort® Aqua™ had lower rhinitis-related healthcare
costs over a 1-year period than patients treated with the
antihistamine loratadine, despite data suggesting that patients in
the Rhinocort® Aqua™ group may have had more severe
rhinitis (Figure 5) (Roberts et al 2003).
Figure
5. Mean rhinitis-related healthcare charges over a 1-year period by
month and pre- and post-index total rhinitis-related costs in 3492
patients with allergic rhinitis (Roberts et al 2003)
|
| 2. Is
Rhinocort® more cost-effective than surgical removal of nasal
polyps? |
A recent study of different
treatment strategies for patients with nasal polyps in Sweden
investigated the cost-effectiveness of initial treatment with
Rhinocort® compared with initial polypectomy (Berggren &
Johansson 2003). The study showed that initial treatment with
Rhinocort® 128 µg twice daily was the least expensive way
to generate treatment successes, defined as improvement in at least
three of the following; polyp size, symptoms, sense of smell, overall
treatment efficacy and peak nasal expiratory flow index (Table 1) and
that Rhinocort® has the potential to reduce healthcare costs by
more than 50% compared with surgery (Berggren & Johansson
2003).
Table
1. Cost per patient in SEK for treatment and surgical treatment with
three alternative polypectomy procedures (SEK8= $US1, yearly average
in 1998) (Berggren & Johansson 2003)
|
| 3. References |
Berggren
F, Johansson L. Cost effectiveness of nasal budesonide versus
surgical treatment for nasal polyps. Pharmacoeconomics 2003;
21: 351–356.
Crystal-Peters
J, Crown WH, Goetzel RZ, Schutt DC. The cost of productivity losses
associated with allergic rhinitis. Am J Manag Care 2000; 6:
373–378.
Lee
TA, Divers CH, Leibman CW. Evaluating the efficiency of treatment in
the allergic rhinitis market. J Manag Care Pharm 2004; 10:
S3–S8.
Mackowiak
J. The health and economic impact of rhinitis. Am J Manag Care
1997; 3: S8–S18.
McMenamin
P. Costs of hay fever in the United States in 1990. Ann Allergy
1994; 73: 35–39.
Reissman
D, Price T, Leibman CW. Cost efficiency of intranasal corticosteroid
prescribing patterns in the management of allergic rhinitis.
J Manag Care Pharm 2004; 10: S9–S13.
Roberts
CS, Leibman C, McLaughin T. Healthcare cost
analysis of allergic rhinitis treatment: budesonide aqueous nasal
spray versus loratadine. J Allergy Clin Immunol 2003;
111: S108, Abs 155.
Ståhl
E, van Rompay W, Wang EC, Thomson DM. Cost-effectiveness analysis of
budesonide aqueous nasal spray and fluticasone propionate nasal spray
in the treatment of perennial allergic rhinitis. Ann Allergy
Asthma Immunol 2000; 84: 397–402.
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