Economic Evaluation of Ribosomal Immunotherapy in Patients with Chronic Ear, Nose and Throat and Respiratory Tract Infections

Abstract

This study analyses the economic value of ribosomal immunotherapy in patients with chronic ear, nose and throat (ENT) infections and respiratory tract infections (RTI) as compared with patients not receiving prophylaxis. Specifically, the objective was to determine whether the incremental costs of ribosomal immunotherapy could be offset by healthcare savings through a reduction in recurrent episodes of acute infection. The study was conducted from the payer perspective in the Italian healthcare setting. A 6-month time-frame was used in the decision analysis model, and costs reflect 1995 values. The model incorporated international clinical trial data and Italian resource use data for adult patients with chronic sinusitis and bronchitis and children with recurrent ENT infections. The findings indicate that ribosomal immunotherapy is capable of generating net direct cost savings over 6 months ranging between 280 000 and 1 100 000 Italian lire (L) per patient (L1700 approximately $US1) depending on the type of chronic disease studied (otitis media or rhinopharyngitis in children, sinusitis or bronchitis in adults). Threshold incremental efficacy of immunoprophylaxis required to achieve cost equivalence compared with no prophylaxis ranged between 2 and 20%, depending on the indication and the magnitude of treatment cost associated with an acute infectious episode (low/best/high estimate) considered. In view of the incremental efficacy rates observed in clinical trials ranging between 40 and 65% for patients with ribosomal immunoprophylaxis, prevention of recurrent ENT infections and RTI appears to be an economically meaningful therapeutic strategy, even when assuming that efficacy rates achievable in real clinical practice may be lower than those reported in clinical trials. On the basis of these findings for Italy, physicians should give increased attention to ribosomal immunoprophylaxis of chronic respiratory diseases in children and adults.