Cost of allergy immunotherapy: sublingual vs subcutaneous administration

Allergy immunotherapy is an effective way to manage the allergic patient and may be administered either through the subcutaneous route (SCIT) or the sublingual route (SLIT). Both have been proven efficacious; however, SLIT is currently not covered by insurance companies and is an out-of-pocket expense. The goal of the current study is to compare the costs of SCIT to SLIT.

For SCIT, a total of 9 different insurance groups were studied including 8 preferred provider organizations (PPOs) and Medicare. Costs were broken down according to the percentage of coverage for the injections, serum vial fees, weekly co-pay, and deductibles. Total yearly cost for SCIT was calculated for the varying insurance plans and compared to the yearly cost of SLIT.

PPO plans covered between 60% and 100% of allergy immunotherapy treatment with a range of weekly co-pay between $0 and $50. Deductibles ranged between $0 and $7000. Medicare had a flat rate of 80% coverage costing the insurer $807.20 for the year of therapy. None of the above costs include loss of work productivity and travel expense. The cost of SLIT ranged from $500 to $2100 depending on the allergy practice and number on antigens treated.

The cost of SCIT varies dramatically according to insurance plan whereas the cost of SLIT varies between practices. When loss of productivity and travel expense are added into the cost of SCIT, SLIT might be comparable in cost and more convenient for the patient. Although the lack of insurance coverage for SLIT currently makes it more expensive than SCIT, we have found that the financial gap is much smaller than initially thought, especially when indirect costs and plans with less than 80% coverage or high weekly co-pay are factored into the equation.