Background

Allergen immunotherapy (AIT) is safe and effective but is typically administered under strict clinic observation to mitigate the risk of a systemic reaction to immunotherapy (SRIT). However, in the setting of the global coronavirus disease 2019 pandemic, alternative care models should be explored.

Objective

To evaluate the cost-effectiveness of home immunotherapy self-administration (HITSA) in a highly idealized circumstance for provision of maintenance AIT in a shelter-in-place or other scenarios of unforeseen reduction in nonessential medical services.

Methods

Markov modeling was used to compare in-office clinic AIT in selected patients using cohort analysis and microsimulation from the societal and health care perspectives.

Results

Assuming similar SRIT rates, HITSA was found to be a cost-effective option with an incremental cost-effectiveness ratio of $44,554/quality-adjusted life-year when considering both incremental epinephrine autoinjector costs and coronavirus disease 2019 risks. Excluding epinephrine autoinjector costs, HISTA dominated other options. However, outside of pandemic considerations, HITSA was not cost-effective (incremental cost-effectiveness ratio, $198,877,286) at annual epinephrine autoinjector costs above $287. As the incremental HITSA SRIT rate increased above 15%, clinic AIT was the most cost-effective strategy. Excluding both pandemic risks and risk of motor vehicle accident fatality from round-trip clinic transit, clinic AIT dominated other strategies. Clinic AIT was the more cost-effective option at very high fatality relative risk for HITSA or at very low annual risk of contracting coronavirus disease 2019.

Conclusions

Under idealized assumptions HITSA can be a safe and cost-effective option during a global pandemic in appropriately selected patients provided home rates of SRIT remain stable.

中文翻译：

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COVID-19 大流行期间具有高健康素养的特定患者的家庭维护过敏原免疫疗法的健康和经济成果：特殊时期的成本效益分析。

 背景

过敏原免疫疗法（AIT）安全有效，但通常在严格的临床观察下进行，以降低免疫疗法（SRIT）全身反应的风险。然而，在2019年冠状病毒病全球大流行的背景下，应探索替代护理模式。

 客观的

评估在高度理想化的情况下，在就地避难所或其他非必要医疗服务意外减少的情况下提供维持性 AIT 的家庭免疫治疗自我管理 (HITSA) 的成本效益。

 方法

马尔可夫模型用于从社会和医疗保健角度使用队列分析和微观模拟来比较选定患者的门诊 AIT。

 结果

假设 SRIT 率相似，在考虑增量肾上腺素自动注射器成本和 2019 年冠状病毒病风险时，HITSA 被发现是一种具有成本效益的选择，增量成本效益比为 44,554 美元/质量调整生命年。排除肾上腺素自动注射器的成本，HISTA 在其他选择中占主导地位。然而，除了大流行的考虑之外，当肾上腺素自动注射器的年度成本超过 287 美元时，HITSA 并不具有成本效益（增量成本效益比为 198,877,286 美元）。随着增量 HITSA SRIT 率增加到 15% 以上，诊所 AIT 成为最具成本效益的策略。排除大流行风险和往返诊所交通导致的机动车事故死亡风险，诊所 AIT 主导了其他策略。在 HITSA 死亡率相对风险非常高或感染 2019 年冠状病毒病的年度风险非常低的情况下，诊所 AIT 是更具成本效益的选择。

 结论

在理想化假设下，在全球大流行期间，只要 SRIT 的入院率保持稳定，对于适当选择的患者，HITSA 可能是一种安全且具有成本效益的选择。