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Quantifying the benefits of early sublingual allergen immunotherapy tablet initiation in children
Eckard Hamelmann1, Eva Hammerby2, Katrine Skaarup Scharling2
1Children's Center Bethel, Bielefeld University, Bielefeld, Germany.
Insights
Starting sublingual allergen immunotherapy (SLIT tablets) for allergic rhinitis (AR) in young children significantly lowers the risk of developing allergic asthma (AA) and reduces long-term healthcare costs. Early intervention in childhood offers lasting clinical benefits for AR patients.
Area of Science:
- Allergy and Immunology
- Pediatrics
- Health Economics
Background:
- Allergic rhinitis (AR) is a chronic upper airway inflammatory condition.
- Up to 45% of children with AR may develop allergic asthma (AA).
- Sublingual allergen immunotherapy (SLIT tablets) is a treatment option for AR.
Purpose of the Study:
- To evaluate the clinical and economic benefits of early childhood initiation of SLIT tablets for AR.
- To quantify the long-term reduction in new cases of allergic asthma (AA) following early SLIT tablet treatment.
- To assess the impact of early SLIT tablet initiation on healthcare costs in children with AR.
Main Methods:
- A Markov model was utilized to simulate the long-term effects of SLIT tablets on asthma development.
- Data from the GRAZAX® Asthma Prevention trial informed age- and treatment-dependent risks of AA.
- Healthcare costs were estimated using data from the REACT study.
Main Results:
- Initiating SLIT tablets at age 5 reduced AA development to 19% over 20 years, compared to 24% (age 7) and 29% (age 12).
- Early initiation at age 5 resulted in lower 20-year healthcare costs (EUR 20,429) versus later initiation (EUR 21,050 at age 7, EUR 22,379 at age 12).
- A clinically meaningful and permanent reduction in new AA cases was observed with early SLIT tablet initiation.
Conclusions:
- Early childhood initiation of SLIT tablets for AR provides significant long-term clinical benefits.
- Starting SLIT tablets early in children with AR leads to a substantial decrease in allergic asthma development.
- Early SLIT tablet treatment is associated with reduced overall healthcare expenditures in pediatric AR patients.
Background:
Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airway, which progresses into allergic asthma (AA) in up to 45% of children. This analysis aimed to investigate clinical and economic benefits of sublingual allergen immunotherapy (SLIT tablets) initiated early in childhood for the treatment of AR by quantifying the long-term reduction in new cases of AA.
Methods:
A Markov model was developed to estimate the long-term effects of SLIT tablets on the risk of developing asthma. Key parameters were primarily based on data from the GRAZAX® Asthma Prevention trial and included the age- and treatment-dependent risk of developing AA as well as annual probabilities of progression/remission in AR severity. Healthcare costs were estimated using data from the REACT study.
Results:
In a modelled cohort of children with moderate-to-severe seasonal AR initiated on SLIT tablets at ages 7 and 12, 24% and 29%, respectively, develop AA during a 20-year period. In comparison, when initiated at age 5, 19% develop AA. Additionally, initiation of SLIT tablets at age 5 is associated with a total healthcare cost of EUR 20,429 per patient, whereas initiation at ages 7 and 12 is associated with, respectively, EUR 21,050 and EUR 22,379 per patient 20 years after AR diagnosis.
Conclusion:
Initiation of SLIT tablets in early childhood is associated with a clinically meaningful and permanent reduction in new cases of AA and lower healthcare costs among children with AR. This finding supports the clinical relevance of initiating SLIT tablets early for children with AR to obtain long-term clinical benefits.
