An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease

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.

Key words: Cost-effectiveness analysis, quality-adjusted life year, aspirin desensitization, aspirin-exacerbated respiratory disease

Abbreviations used: AERD, Aspirin-exacerbated respiratory disease, CPT, Current procedural terminology, ICD-9, Internation Classification of Diseases, Ninth Revision, ICER, Incremental cost-effectiveness ratio, NSAID, Nonsteroidal anti-inflammatory drug, QALY, Quality-adjusted life year