A cost minimization analysis of Azelastine/Fluticasone combination nasal spray versus Azelastine and Fluticasone nasal sprays monotherapy in moderate to severe allergic rhinitis in Iran
Abstract
Background: Allergic Rhinitis (AR) is a symptomatic disorder which is due to allergen exposure and IgE inflammatory pathway activation in respiratory tract. The present study’s purpose was to assess Azelastine/Fluticasone combination nasal spray cost-effectiveness in comparison with Azelastine and Fluticasone nasal sprays monotherapy, in mild to moderate AR patients in Islamic Republic of Iran (I.R.I.) health care system.Methods: A literature review was performed in order to compare the effectiveness of Fluticasone/Azelastine (50μg/125μg) with Fluticasone (50μg) and Azelastine (125μg). The search was conducted in PubMed, ISI, Scopus, Cochrane, CRD York and Google Scholar based on a predefined PICO of the study. According to confirmed equal clinical effectiveness of two arms, a cost minimization analysis was done. As micro costing, direct medical costs (drugs` costs, GP office visits, office visit and allergy-related tests), based on official tariffs in Iran were calculated in a 14-day time horizon. Because of model’s time horizon, which was less than 1 year, discount rate was not applied.Results: The result of literature search were two RCTs in which the combination form had been compared with each of the spray of Azalastine and Fluticasone. Azelastine/Fluticasone would save 2.05$ per patient for each course of treatment; and therefore recognized as cost-effective.Conclusions: This study showed that Azelastine/Fluticasone combination was the cost saving alternativeKhaltaev N, Bousquet J. Allergic Rhinitis and its Impact on Asthma Update (ARIA 2008) The Perspective From Spain. J Investig Allergol Clin Immunol. 2008;18(5):327-34.
Van Cauwenberge P, Bachert C, Passalacqua G, Bousquet J, Canonica G, Durham S, et al. Consensus statement on the treatment of allergic rhinitis. Allergy. 2000;55(2):116-34.
Fairchild CJ, Durden E, Cao Z, Smale P. Outcomes and cost comparison of three therapeutic approaches to allergic rhinitis. American journal of rhinology & allergy. 2011;25(4):257-62.
Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. Journal of Allergy and Clinical Immunology. 2001;108(1):S2-S8.
Sur DK, Plesa ML. Treatment of Allergic Rhinitis. American family physician. 2015;92(11).
Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Annals of Allergy, Asthma & Immunology. 1998;81(5):478-518.
Casale TB, Blaiss MS, Gelfand E, Gilmore T, Harvey PD, Hindmarch I, et al. First do no harm: managing antihistamine impairment in patients with allergic rhinitis. Journal of Allergy and Clinical Immunology. 2003;111(5):S835-S42.
Kay GG, Plotkin KE, Quig MB, Starbuck VN, Yasuda S. Sedating effects of AM/PM antihistamine dosing with evening chlorpheniramine and morning terfenadine. Am J Managed Care. 1997;3:1843-8.
Harding SM. The human pharmacology of fluticasone propionate. Respiratory Medicine. 1990;84:25-9.
Nathan RA, Bronsky E, Fireman P, Grossman J, LaForce C, Lemanske Jr R, et al. Once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis. Annals of allergy. 1991;67(3):332-8.
Meltzer EO, Weiler JM, Dockhorn RJ, Widlitz MD, Freitag JJ. Azelastine nasal spray in the management of seasonal allergic rhinitis. Annals of allergy. 1994;72(4):354-9.
Bernstein JA. Azelastine hydrochloride: a review of pharmacology, pharmacokinetics, clinical efficacy and tolerability. Current medical research and opinion. 2007;23(10):2441-52.
Ratner PH, Hampel F, Van Bavel J, Amar NJ, Daftary P, Wheeler W, et al. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Annals of Allergy, Asthma & Immunology. 2008;100(1):74-81.
Hampel FC, Ratner PH, Van Bavel J, Amar NJ, Daftary P, Wheeler W, et al. Double-blind, placebo-controlled study of azelastine and fluticasone in a single nasal spray delivery device. Annals of Allergy, Asthma & Immunology. 2010;105(2):168-73.
Cardell L-O, Olsson P, Andersson M, Welin K-O, Svensson J, Tennvall GR, et al. TOTALL: high cost of allergic rhinitis—a national Swedish population-based questionnaire study. NPJ Primary Care Respiratory Medicine. 2016;26:15082.
Arnedo-Pena A, Romeu-Gracia MA, Bellido-Blasco JB, Meseguer-Ferrer N, Silvestre-Silvestre E, Conde F, et al. Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain). Allergol Immunopathol. 2017;45(3):251-7.
May U. [Socio-economic impact of allergic rhinitis and perspectives of appropriate therapy]. MMW Fortschritte der Medizin. 2014;156 Suppl 2:39-47.
Harrow B, Sedaghat AR, Caldwell-Tarr A, Dufour R. A Comparison of Health Care Resource Utilization and Costs for Patients with Allergic Rhinitis on Single-Product or Free-Combination Therapy of Intranasal Steroids and Intranasal Antihistamines. Journal of managed care & specialty pharmacy. 2016;22(12):1426-36.
| Files | ||
| Issue | Vol 3 No 1/2 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Azelastine Fluticasone Nasal spray Allergic Rhinitis | ||
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