Cost-effectiveness analysis of corticosteroid nasal sprays for allergic rhinitis in Japan

Inflammation of the nasal lining, resulting in rhinorrhea and sneezing, leads to productivity losses.

We aimed to clarify which corticosteroid nasal spray, dexamethasone cipecilate, fluticasone furoate, fluticasone propionate, or mometasone furoate hydrate, is more cost-effective in treating allergic rhinitis in Japan from the perspective of healthcare payers.

A decision tree was generated using data on transition probabilities of effectiveness and side effects retrieved from post-marketing surveillance data. Direct medical costs were sourced from Medical Fee Index 2022. The drug prices were determined using the Drug Price Index 2021. Utilities were determined using the EQ-5D-5L scale. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of the results. Prescription data for the fiscal year 2020 were also examined.

The incremental cost of mometasone furoate hydrate, dexamethasone cipecilate, and fluticasone furoate compared with that of fluticasone propionate was 200 JPY (1.99 USD), 440 JPY (4.37 USD), and 760 JPY (7.54 USD), respectively. The incremental effectiveness of mometasone furoate hydrate, dexamethasone cipecilate, and fluticasone furoate compared with that of fluticasone propionate was -0.0004, -0.0004, and -0.0002, respectively. Thus, mometasone furoate hydrate, dexamethasone cipecilate, and fluticasone furoate were dominated by fluticasone propionate. The sensitivity analyses showed that the result was robust. Prescription data showed that fluticasone furoate was prescribed most often, followed by mometasone furoate hydrate.

Fluticasone propionate is the most cost-effective agent. As it was not often prescribed in the fiscal year 2020, physicians should understand our results to sustain the reduction of healthcare expenditures.