{"title":"A Multistate Markovian Model of the Economic Burden for Allergy Immunotherapy","authors":"Massimo Bilancia, Gaetano Serviddio","doi":"10.1002/asmb.70017","DOIUrl":null,"url":null,"abstract":"<div>\n \n <p>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.</p>\n </div>","PeriodicalId":55495,"journal":{"name":"Applied Stochastic Models in Business and Industry","volume":"41 3","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Applied Stochastic Models in Business and Industry","FirstCategoryId":"100","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/asmb.70017","RegionNum":4,"RegionCategory":"数学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MATHEMATICS, INTERDISCIPLINARY APPLICATIONS","Score":null,"Total":0}
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.
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.