An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease

• Published in: Journal of allergy and clinical immunology Vol. 121; no. 1; pp. 81 - 87
• Main Authors: Shaker, Marcus, MD, Lobb, Ano, BA, Jenkins, Pamela, MD, PhD, O'Rourke, Daniel, MD, Takemoto, Steve K., PhD, Sheth, Salil, MHA, Burroughs, Thomas, PhD, Dykewicz, Mark S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2008; Elsevier; Elsevier Limited
• Subjects: Adult; Allergy and Immunology; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - economics; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - adverse effects; Aspirin - economics; Aspirin - therapeutic use; aspirin desensitization; aspirin-exacerbated respiratory disease; Asthma - etiology; Asthma - therapy; Biological and medical sciences; Cardiovascular Diseases - prevention & control; Cost-Benefit Analysis; Cost-effectiveness analysis; Desensitization, Immunologic - economics; Desensitization, Immunologic - methods; Discount rates; Drug Hypersensitivity - etiology; Drug Hypersensitivity - therapy; Drug therapy; Fatalities; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Markov Chains; Medical sciences; Middle Aged; Models, Biological; Mortality; Platelet Aggregation Inhibitors - therapeutic use; quality-adjusted life year; Quality-Adjusted Life Years; Respiration Disorders - etiology; Respiration Disorders - therapy; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Ticlopidine - analogs & derivatives; Ticlopidine - economics; Ticlopidine - therapeutic use; Incremental cost-effectiveness ratio; aspirin desensitization; ICER; CPT; NSAID; aspirin-exacerbated respiratory disease; AERD; quality-adjusted life year; Cost-effectiveness analysis; ICD-9; Internation Classification of Diseases, Ninth Revision; Nonsteroidal anti-inflammatory drug; QALY; Current procedural terminology; Prostaglandin-endoperoxide synthase; Economic analysis; Immunopathology; Quality-adjusted life years; Desensitization; Enzyme; Respiratory disease; Enzyme inhibitor; Acetylsalicylic acid; Antiplatelet agent; Immunology; Health economy; Oxidoreductases; Salicylates; Cost efficiency analysis
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2007.06.047

Background Aspirin desensitization is an effective therapy for moderate-to-severe aspirin-exacerbated respiratory disease (AERD). Desensitization also allows the use of aspirin for secondary cardiovascular prevention. Objective We sought to investigate the cost-effectiveness of aspirin desensitization with subsequent aspirin therapy in patients with AERD. Methods The Healthcare Cost and Utilization Project was used, together with average reimbursements from a large Midwestern health care plan, to model the costs of aspirin desensitization for therapeutic and prophylactic use in patients with AERD. Event probabilities were based on the published literature. Results Ambulatory desensitization for AERD cost $6768 per quality-adjusted life year (QALY) saved ($18.54 per additional symptom-free day). Aspirin desensitization for AERD remained cost-effective (<$50,000 per QALY saved) across a wide range of assumptions. When secondary cardiovascular prophylaxis was considered, ambulatory aspirin desensitization was less expensive than an alternative antiplatelet agent, clopidogrel. Clopidogrel cost $106,453 per incremental QALY saved when compared with desensitization. Conclusions Aspirin desensitization is a cost-effective therapeutic intervention in patients with moderate-to-severe AERD. Although the incremental cost-effectiveness of clopidogrel in individuals with aspirin allergy is marginal, if available, ambulatory desensitization remains a less-expensive option for secondary cardiovascular prophylaxis.