Letters to the Editor: Assessing the cost-effectiveness of allergen immunotherapy in allergic rhinitis

The authors of the article, “Decision-Making Analysis for Allergen Immunotherapy versus Nasal Steroids in the Treatment of Nasal Steroid-Responsive Allergic Rhinitis,” must be commended, because they introduce an original approach to assess the cost-effectiveness of subcutaneous immunotherapy (SCIT). It is a pity that they did not take into account also sublingual immunotherapy (SLIT), which is going to be available in the United States after the demonstration of efficacy of the recent pharmaceutical-quality preparations in tablets. Indeed, the authors cite the article by Podladnikova et al., who showed that SLIT had an economic advantage over SCIT, but they do not discuss this. Moreover, the finding is based on the prices of immunotherapy products in the Czech Republic, while in other countries the prices may be largely variable and often they are much higher. Globally, pharmacoeconomic studies from Europe have shown that immunotherapy (in both SCIT and SLIT forms) may be very beneficial to the health care systems. In particular, a budget impact analysis showed that SLIT with grass tablets is a cost-saving alternative to SCIT in patients with grass pollen–induced allergic rhinoconjunctivitis. Applying the model proposed by Kennedy et al. would have been (and surely will be in future studies) very interesting to further evaluate this issue