Meta-analysis and cost-effectiveness analysisof intranasal corticosteroid treatment in allergic rhinitiswith ocular symptoms
Chadakan Yan,1 Phichayut Phinyo,2-4 Bussakorn Mahakkanukrauh,1 Torsak Bunupuradah,1
Manish Verma,5 Abhay Phansalkar,6 Bhumika Aggarwal6
Affiliations:
1 GlaxoSmithKline Limited, Bangkok, Thailand
2 Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
3 Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
4 Musculoskeletal Science and Translational Research (MSTR) Center, Chiang Mai University, Chiang Mai, Thailand
5 Respiratory and Allergy, GlaxoSmithKline plc., Mumbai, India
6 GlaxoSmithKline Limited, Singapore
Abstract
Background: Intranasal corticosteroid (INCS) has a beneficial effect on ocular symptoms in allergic rhinitis (AR). To our knowledge, the cost-effectiveness of available INCS for AR with ocular symptoms is yet to be demonstrated.
Objective: To evaluate the cost-effectiveness of INCSs including Budesonide (BANS), Mometasone furoate (MFNS), Triamcinolone (TANS), and Fluticasone furoate (FFNS) on ocular symptoms associated with AR in the Thai context.
Methods: The percentage of effectiveness in improving total ocular symptoms score (TOSS) was derived from the result of a meta-analysis that estimated the SMD of each INCS treatment compared to placebo as clinical input parameters. A cost-effectiveness analysis based on a decision-tree model to assess one-year costs and outcomes from a Thai societal perspective. The outcomes were to compare incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analyses (PSA) were also conducted to capture parameter uncertainties.
Results: 13 eligible RCTs with a total of 3,722 patients with SAR were included in the analysis. The percentage of effectiveness of FFNS, MFNS, TANS, and BANS was 59.89%, 45.60%, 24.89%, and 16.00%, respectively. The ICER of FFNS, MFNS, and TANS is THB -6,539.92, 4,593.83, and 1,401.24 compared to BANS. CECA result showed the probability of using FFNS is considered cost-effective in 87.50% of cases from zero value followed by MFNS (0.80%), TANS (5.40%), and BANS (6.30%). With a threshold greater than THB 20,000, FFNS is considered a cost-effective strategy.
Conclusion: FFNS is a cost-effective option compared to alternative INCSs in Thailand for treating AR with ocular symptoms.
Key words: allergic rhinitis, ocular symptom, intranasal corticosteroids, cost-effectiveness, economic evaluation