Cost-effectiveness of antihistaminics in adults' patients with allergic rhinitis

Allergic rhinitis (AR) is highly prevalent worldwide, often leading to substantial healthcare costs and diminished patient quality of life. Although guidelines frequently recommend intranasal corticosteroids, oral second-generation antihistamines remain commonly used in many low- and middle-income countries. We performed a cost-utility analysis of newer-generation oral H1 antihistamines for adults with intermittent AR in Colombia.

A 28-day decision-tree model compared multiple antihistamines' costs and quality-adjusted life years (QALYs). Inputs included clinical effectiveness and adverse-event probabilities from systematic reviews and network meta-analyses. All costs, expressed in 2024 US dollars (1 USD = 4,400 COP), were adjusted for inflation. Net monetary benefits (NMB) were calculated using willingness-to-pay thresholds for Colombia (US$ 5130). Probabilistic sensitivity analyses were conducted to assess uncertainty in key parameters.

Cetirizine 10 mg and fexofenadine 180 mg were the only undominated strategies, exhibiting higher NMB values than other antihistamines. Deterministic analysis showed that cetirizine had a lower total cost (22.15 USD) and an ICER of 349.62 USD per QALY gained. In contrast, fexofenadine provided a slight gain in effectiveness at a modest incremental cost. Probabilistic analysis confirmed fexofenadine as cost-effective option across a wide range of thresholds, with cetirizine remaining a strong contender at lower thresholds.

In this cost-utility analysis of oral H1 antihistamines for adults with intermittent allergic rhinitis in Colombia, cetirizine 10 mg and fexofenadine 180 mg emerged as the cost-effective options, offering high net monetary benefits and remaining undominated in deterministic and probabilistic analyses.