Abstract
Background: Until now, the cost of allergy treatment in the insured public health care system and the non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective: To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in a non-insured self-financing private health care system. Methods: A retrospective cohort study conducted from 2015 until 2020 that compared the clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1098 subjects. Results: A decrease in sp-HDM-IgE level (kU/mL) from 20.5 + 8.75 kU/mL to 12.1 + 3.07 kU/mL was observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT, it costs IDR 21,753,062.7 per child, and for non-SCIT, it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT, it costs IDR 17,024,138.8, while with non-SCIT, it costs IDR 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT, it costs IDR 9,550,126.6, while with non-SCIT, it costs IDR 52,073,938.9. Conclusions: In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.
Highlights
Allergic rhinitis (AR) is one of the most important diseases of the natural course of allergic disease [1]
A total of 2196 children with allergic rhinitis from 92 Districts in the Republic of Indonesia were recruited as subjects of this study, they came from (District and number of children): Surabaya 879, Sidoarjo 425, Jombang 135, Kupang 95, Lamongan 77, Gresik 40, Kediri 31, Pamekasan 31, Sampang 31, Jember 30, Sumenep 29, Mataram 28, Lumajang 27, Tulungagung 24, Mojokerto 21, Tuban 20, Balikpapan 18, Pasuruan 17, Bangkalan 16, Bojonegoro 14, Madiun
Our study found that compared to the first semester of subcutaneous immunotherapy (SCIT) initiation, the average total health care cost per patient in semester 3 was 73% lower during 18 months of SCIT, while those who were not immunotherapy were only 52% lower
Summary
Allergic rhinitis (AR) is one of the most important diseases of the natural course of allergic disease [1]. AR that is not well controlled will burden patients, nurses, employers, and the health care system [3,4]. Children with uncontrolled AR have a greater risk of developing asthma, recurrent otitis media, chronic rhinosinusitis, and other comorbid conditions [5,6]. The economic costs of poorly controlled AR include: the cost of nonprescription drugs to treat symptoms, prescription drug costs, and the cost of medical care for comorbid complications, such as asthma and acute sinusitis [9]. Indirect costs of uncontrolled AR include absenteeism from school, decreased productivity of children and their parents, loss of parents’ daily wages, and injuries resulting from fatigue [3,9,10]
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