[Is AIT worth your while? Economic evaluation of allergen-specific immunotherapy (AIT) for otorhinolaryngologists in private practice].

Abstract

The burden of allergic diseases is significant for patients, payers in the healthcare system, and the political economy. Numerous studies have demonstrated the efficacy and cost-effectiveness of allergen immunotherapy (AIT) compared to symptomatic treatments. However, allergic patients in Germany often do not receive adequate treatment. This study aims to investigate the reimbursement of allergy diagnostics and AIT for ear, nose, and throat (ENT) physicians in private practice. A model calculation was conducted to assess the reimbursement of allergology services across 12 statutory health insurance associations (Kassenärztliche Vereinigungen, KV) based on the Physician Fee Schedule (Einheitlicher Bewertungsmaßstab, EBM) and KV-specific regulations for the year 2022 [20, 22]. Reimbursement was calculated according to EBM values and with a reduced point value. Quarterly reimbursement for a 3-year therapy and hourly rates for subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) were analyzed and compared with the average reimbursement per case (durchschnittlicher Honorarumsatz je Behandlungsfall, DHPB). Adherence to the budget resulted in ENT physicians being reimbursed above the DHPB for SCIT in every KV. This remained true for most KVs, even when the excess to the case value was only rewarded at 15%. Reimbursement for a 3-year SLIT was lower than the DHPB across all KVs. Allergy diagnostics and AIT represent economically advantageous options for ENT practices. Maintenance therapy demonstrates a positive cost-benefit ratio, supporting the call for a consistent 3‑year treatment regimen.