过敏原免疫疗法治疗过敏性鼻炎，哮喘，食物过敏和毒液过敏的效益分析
2018/05/08
摘要
欧洲变态反应和临床免疫学会（EAACI）正在制定变应原免疫治疗（AIT）指南，用于管理过敏性鼻炎，过敏性哮喘，IgE介导的过敏性疾病。我们进行了这项系统综述，以批判性评估AIT的有效性、安全性和成本效益。我们在每个领域制作了摘要证据，然后综合了最近关于过敏性鼻炎、哮喘、食物过敏和毒液过敏的四项系统综述所确定的健康经济数据。这些研究的质量是通过使用批判性评估技能计划工具进行健康经济评估的独立评估的。23项研究符合我们的纳入标准。其中19项研究调查了AIT在过敏性鼻炎中的成本效益，其中7项是随机对照试验，并从卫生系统角度进行经济评估。这一组证据表明，使用英国国家卫生与临床卓越研究所（NICE）成本效益阈值（20，000英镑/质量调整生命年（QALY））来评价，舌下免疫疗法（SLIT）和皮下免疫疗法（SCIT）将被视为具有成本效益。但是，在解释这些结果时，应该考虑到研究的质量以及对不确定性和缺失数据的处理。对于哮喘，有三项符合条件的研究，所有这些研究都有明显的方法学限制。这些研究表明SLIT在用于哮喘和过敏性鼻炎患者时可能具有成本效益，并且每QALY的成本效益比（ICER）增加了10,726英镑。我们发现了一个关于毒液过敏的经济模型研究，尽管主要是基于专家意见和似是而非的假设，但对于蜜蜂和黄蜂毒液过敏的治疗可能只对那些可能暴露于多种高危致敏毒液（如养蜂人）的高危人群具有成本效益。我们没有发现关于AIT治疗食物过敏的成本效益的合格研究。总的来说，支持AIT成本效益的证据有限且研究质量较差，但仍表明AIT可能对伴或不伴哮喘的过敏性鼻炎患者和高风险亚组的毒液过敏者具有成本效益。我们无法得出关于AIT食物过敏的成本效益的任何结论。
Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview
Asaria M, Dhami S, van Ree R, Gerth van Wijk R, Muraro A, Roberts G, Sheikh A.
欧洲变态反应和临床免疫学会（EAACI）正在制定变应原免疫治疗（AIT）指南，用于管理过敏性鼻炎，过敏性哮喘，IgE介导的过敏性疾病。我们进行了这项系统综述，以批判性评估AIT的有效性、安全性和成本效益。我们在每个领域制作了摘要证据，然后综合了最近关于过敏性鼻炎、哮喘、食物过敏和毒液过敏的四项系统综述所确定的健康经济数据。这些研究的质量是通过使用批判性评估技能计划工具进行健康经济评估的独立评估的。23项研究符合我们的纳入标准。其中19项研究调查了AIT在过敏性鼻炎中的成本效益，其中7项是随机对照试验，并从卫生系统角度进行经济评估。这一组证据表明，使用英国国家卫生与临床卓越研究所（NICE）成本效益阈值（20，000英镑/质量调整生命年（QALY））来评价，舌下免疫疗法（SLIT）和皮下免疫疗法（SCIT）将被视为具有成本效益。但是，在解释这些结果时，应该考虑到研究的质量以及对不确定性和缺失数据的处理。对于哮喘，有三项符合条件的研究，所有这些研究都有明显的方法学限制。这些研究表明SLIT在用于哮喘和过敏性鼻炎患者时可能具有成本效益，并且每QALY的成本效益比（ICER）增加了10,726英镑。我们发现了一个关于毒液过敏的经济模型研究，尽管主要是基于专家意见和似是而非的假设，但对于蜜蜂和黄蜂毒液过敏的治疗可能只对那些可能暴露于多种高危致敏毒液（如养蜂人）的高危人群具有成本效益。我们没有发现关于AIT治疗食物过敏的成本效益的合格研究。总的来说，支持AIT成本效益的证据有限且研究质量较差，但仍表明AIT可能对伴或不伴哮喘的过敏性鼻炎患者和高风险亚组的毒液过敏者具有成本效益。我们无法得出关于AIT食物过敏的成本效益的任何结论。
(中日友好医院呼吸与危重症医学科 王圆方 摘译 林江涛 审校)
(Allergy. 2018 Feb;73(2):269-283. doi: 10.1111/all.13254. Epub 2017 Sep 18.)
(Allergy. 2018 Feb;73(2):269-283. doi: 10.1111/all.13254. Epub 2017 Sep 18.)
Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview
Asaria M, Dhami S, van Ree R, Gerth van Wijk R, Muraro A, Roberts G, Sheikh A.
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE-mediated food allergy and venom allergy. To inform the development of clinical recommendations, we undertook systematic reviews to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT for these conditions. This study focusses on synthesizing data and gaps in the evidence on the cost-effectiveness of AIT for these conditions.We produced summaries of evidence in each domain, and then, synthesized findings on health economic data identified from four recent systematic reviews on allergic rhinitis, asthma, food allergy and venom allergy, respectively. The quality of these studies was independently assessed using the Critical Appraisal Skills Programme tool for health economic evaluations.Twenty-three studies satisfied our inclusion criteria. Of these, 19 studies investigated the cost-effectiveness of AIT in allergic rhinitis, of which seven were based on data from randomized controlled trials with economic evaluations conducted from a health system perspective. This body of evidence suggested that sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) would be considered cost-effective using the (English) National Institute for Health and Clinical Excellence (NICE) cost-effectiveness threshold of £20 000/quality-adjusted life year (QALY). However, the quality of the studies and the general lack of attention to characterizing uncertainty and handling missing data should be taken into account when interpreting these results. For asthma, there were three eligible studies, all of which had significant methodological limitations; these suggested that SLIT, when used in patients with both asthma and allergic rhinitis, may be cost-effective with an incremental cost-effectiveness ratio (ICER) of £10 726 per QALY. We found one economic modelling study for venom allergy which, despite being based largely on expert opinion and plausible assumptions, suggested that AIT for bee and wasp venom allergy is only likely to be cost-effective for very high-risk groups who may be exposed to multiple exposures to venom/year (eg bee keepers). We found no eligible studies investigating the cost-effectiveness of AIT for food allergy.Overall, the evidence to support the cost-effectiveness of AIT is limited and of low methodological quality, but suggests that AIT may be cost-effective for people with allergic rhinitis with or without asthma and in high-risk subgroups for venom allergy. We were unable to draw any conclusions on the cost-effectiveness of AIT for food allergy.
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