Reasons for Declining Venom Immunotherapy.

Abstract

Hymenoptera venom allergy is associated with significant morbidity and deterioration in health-related quality of life, andrisk of fatal systemic reactions. Although venom immunotherapy is safe and the only effective treatment in allergic individuals, somepatients prefer not to pursue this treatment. Since 2011, when the 50% reimbursement was stopped, patients must fully support the costof immunotherapy. This study aimed to ascertain the reasons why patients decline immunotherapy. A medical records review of all patients proposed to receive venom immunotherapy at an Allergy and ClinicalImmunology Department in Porto, Portugal, between 2006 and 2015, followed by a phone interview to patients refusing treatment. A total of 83 subjects were enrolled, with a mean (± SD) age of 44.4 (14.7) years and 55 (66%) males; 27 refused venomimmunotherapy between 2006 and 2015. Nineteen were interviewed and 14 of those stated price as the main reason for decliningtreatment. The only identified risk factor associated with immunotherapy refusal was being proposed after 2011 (OR: 3.29; 95% CI:1.12 - 9.68; p = 0.03). The number of patients refusing venom immunotherapy doubled since reimbursement was withdrawn. Price was identifiedas the major obstacle to treatment completion. Immunotherapy proposal after reimbursement was stopped was associated with a 3-foldincrease in the risk of refusing treatment. These findings show how economic decisions may have a detrimental effect on patient care, as immunotherapy refusalleft them exposed to an avoidable life-threatening risk.