An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease
Received 11 December 2006; received in revised form 22 June 2007; accepted 26 June 2007. published online 23 August 2007.
Background
Aspirin desensitization is an effective therapy for moderate-to-severe aspirin-exacerbated respiratory disease (AERD). Desensitization also allows the use of aspirin for secondary cardiovascular prevention.
Objective
We sought to investigate the cost-effectiveness of aspirin desensitization with subsequent aspirin therapy in patients with AERD.
Methods
The Healthcare Cost and Utilization Project was used, together with average reimbursements from a large Midwestern health care plan, to model the costs of aspirin desensitization for therapeutic and prophylactic use in patients with AERD. Event probabilities were based on the published literature.
Results
Ambulatory desensitization for AERD cost $6768 per quality-adjusted life year (QALY) saved ($18.54 per additional symptom-free day). Aspirin desensitization for AERD remained cost-effective (<$50,000 per QALY saved) across a wide range of assumptions. When secondary cardiovascular prophylaxis was considered, ambulatory aspirin desensitization was less expensive than an alternative antiplatelet agent, clopidogrel. Clopidogrel cost $106,453 per incremental QALY saved when compared with desensitization.
Conclusions
Aspirin desensitization is a cost-effective therapeutic intervention in patients with moderate-to-severe AERD. Although the incremental cost-effectiveness of clopidogrel in individuals with aspirin allergy is marginal, if available, ambulatory desensitization remains a less-expensive option for secondary cardiovascular prophylaxis.
aSection of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
cDepartment of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
dSection of Cardiology, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
bCenter for the Evaluative Clinical Sciences, Hanover, NH
eSaint Louis University Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, Mo
fSection of Allergy and Clinical Immunology, Division of Immunobiology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo
Reprint requests: Marcus S. Shaker, MD, Department of Pediatrics and Community and Family Medicine, Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
Disclosure of potential conflict of interest: S. K. Takemoto has consulting arrangements with, has received grant support from, and is on the speakers' bureau for Novartis and Astellas. The rest of the authors have declared that they have no conflict of interest.
ABSTRACT