A Multistate Markovian Model of the Economic Burden for Allergy Immunotherapy

IF 1.3 4区 数学 Q3 MATHEMATICS, INTERDISCIPLINARY APPLICATIONS
Massimo Bilancia, Gaetano Serviddio
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引用次数: 0

Abstract

The incidence of allergic rhinoconjunctivitis due to pollinosis is increasing in Western countries. The first-line therapy (No-AIT) typically involves the administration of antihistamines and corticosteroid sprays to manage symptoms. Immunotherapy represents an alternative treatment option, as it promotes desensitization to allergens. However, it is associated with significant costs. Currently, two types of allergen immunotherapy (AIT) are prescribed: subcutaneous immunotherapy and sublingual immunotherapy. This article compares these two therapeutic options with No-AIT. The comparison is conducted through a cost-effectiveness analysis (CEA), which evaluates health-related outcomes by estimating the incremental cost per unit of change in a composite outcome that combines morbidity and quality-of-life metrics. To perform the analysis, we developed a realistic multistate model describing the progression of a cohort of patients undergoing the three therapeutic approaches. The model was designed to be sufficiently flexible to account for treatment-related challenges commonly observed in real-world settings, which are often inadequately represented in randomized controlled trials. By employing a novel two-dimensional framework, we tracked the proportion of the cohort transitioning between health states during each cycle while simultaneously capturing the origin and destination of each transition. This approach enabled the integration of structural features that are typically overlooked, such as early treatment discontinuation, transition rewards, nonstationarities associated with the usual termination of immunotherapy after three years, and differential protection against severe complications (e.g., asthma) depending on whether immunotherapy was completed or not. Deterministic simulations were conducted using standard input parameters, supplemented by probabilistic simulations to generate CEACs for each of the three strategies. The results from our model indicate that AIT is not cost-effective unless the payer exhibits a moderately high willingness-to-pay. These findings have important implications for the pharmaceutical industry involved in the production of AIT drugs.

变态反应免疫治疗经济负担的多态马尔可夫模型
在西方国家,花粉症引起的变应性鼻结膜炎的发病率正在上升。一线治疗(No-AIT)通常包括使用抗组胺药和皮质类固醇喷雾来控制症状。免疫疗法是另一种治疗选择,因为它能促进对过敏原的脱敏。然而,它伴随着巨大的成本。目前,有两种类型的过敏原免疫治疗(AIT)处方:皮下免疫治疗和舌下免疫治疗。这篇文章比较了这两种治疗方案与无ait。比较是通过成本效益分析(CEA)进行的,该分析通过估算结合发病率和生活质量指标的复合结果中每单位变化的增量成本来评估与健康相关的结果。为了进行分析,我们开发了一个现实的多状态模型来描述一组接受三种治疗方法的患者的进展。该模型被设计得足够灵活,可以解释在现实环境中常见的与治疗相关的挑战,而这些挑战在随机对照试验中往往没有得到充分的体现。通过采用一种新的二维框架,我们跟踪了每个周期中在健康状态之间转换的队列比例,同时捕获了每个转换的起点和终点。这种方法能够整合通常被忽视的结构特征,如早期治疗终止、过渡奖励、通常在三年后终止免疫治疗相关的非平定性,以及取决于免疫治疗是否完成的对严重并发症(如哮喘)的不同保护。使用标准输入参数进行确定性模拟,并辅以概率模拟,为三种策略中的每种策略生成ceac。我们的模型的结果表明,除非付款人表现出中等高的支付意愿,否则在台投资并不具有成本效益。这些发现对参与AIT药物生产的制药行业具有重要意义。
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来源期刊
CiteScore
2.70
自引率
0.00%
发文量
67
审稿时长
>12 weeks
期刊介绍: ASMBI - Applied Stochastic Models in Business and Industry (formerly Applied Stochastic Models and Data Analysis) was first published in 1985, publishing contributions in the interface between stochastic modelling, data analysis and their applications in business, finance, insurance, management and production. In 2007 ASMBI became the official journal of the International Society for Business and Industrial Statistics (www.isbis.org). The main objective is to publish papers, both technical and practical, presenting new results which solve real-life problems or have great potential in doing so. Mathematical rigour, innovative stochastic modelling and sound applications are the key ingredients of papers to be published, after a very selective review process. The journal is very open to new ideas, like Data Science and Big Data stemming from problems in business and industry or uncertainty quantification in engineering, as well as more traditional ones, like reliability, quality control, design of experiments, managerial processes, supply chains and inventories, insurance, econometrics, financial modelling (provided the papers are related to real problems). The journal is interested also in papers addressing the effects of business and industrial decisions on the environment, healthcare, social life. State-of-the art computational methods are very welcome as well, when combined with sound applications and innovative models.
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