Real-world evidence costs of allergic rhinitis and allergy immunotherapy in the commercially insured United States population

Figures & data

Table 1. Demographic characteristics by AIT cohorts.

	25+ AIT FILLS		ANY AIT FILLS		NO AIT FILLS
	N = 45,279		N = 103,207		N = 2,231,323
	N/Mean	%/SD	N/Mean	%/SD	N/Mean	%/SD
Age (Mean, SD)	33.2	18.0	34.2	17.3	32.0	19.2
Age categories (N, %)
18–27	4,269	9.4%	12,357	12.0%	263,302	11.8%
28–37	6,848	15.1%	16,885	16.4%	308,516	13.8%
38–47	8,574	18.9%	20,925	20.3%	361,546	16.2%
48–57	8,001	17.7%	18,564	18.0%	394,717	17.7%
58–65	4,306	9.5%	9,396	9.1%	226,072	10.1%
Sex (N, %)
Male	20,004	44.2%	43,162	41.8%	973,797	43.6%
Female	25,275	55.8%	60,045	58.2%	1,257,526	56.4%
Geographic region (N, %)
Northeast	6,751	14.9%	14,107	13.7%	330,536	14.8%
North Central	8,198	18.1%	15,357	14.9%	384,770	17.2%
South	23,725	52.4%	58,137	56.3%	1,186,081	53.2%
West	6,431	14.2%	15,088	14.6%	319,442	14.3%
Unknown	174	0.4%	518	0.5%	10,494	0.5%
Population density (N, %)
Urban	40,055	88.5%	90,275	87.5%	1,948,820	87.3%
Rural	5,051	11.2%	12,440	12.1%	272,742	12.2%
Unknown	173	0.4%	492	0.5%	9,761	0.4%
Index year (N, %)
2014	14,009	30.9%	33,157	32.1%	727,487	32.6%
2015	14,366	31.7%	33,317	32.3%	736,087	33.0%
2016	13,657	30.2%	29,777	28.9%	602,157	27.0%
2017	3,247	7.2%	6,956	6.7%	165,592	7.4%

Abbreviation. AIT, allergy immunotherapy.

Table 2. Baseline clinical characteristics by AIT cohorts.

	25+ AIT FILLS		ANY AIT FILLS		NO AIT FILLS
	N = 45,279		N = 103,207		N = 2,231,323
	N/Mean	%/SD	N/Mean	%/SD	N/Mean	%/SD
Deyo-Charlson Comorbidity Index (Mean, SD)	0.46	0.72	0.45	0.76	0.22	0.66
Comorbid conditions of interest (N, %)
Any upper respiratory tract infection	28,568	63.1%	62,229	60.3%	762,433	34.2%
Sinusitis	19,291	42.6%	41,897	40.6%	385,113	17.3%
Asthma	15,689	34.6%	31,031	30.1%	166,674	7.5%
Conjunctivitis	12,277	27.1%	22,372	21.7%	98,447	4.4%
Chronic cough	12,074	26.7%	25,033	24.3%	230,975	10.4%
Upper respiratory tract infection	11,631	25.7%	25,969	25.2%	405,578	18.2%
Chronic sinusitis	11,087	24.5%	23,365	22.6%	108,380	4.9%
Heartburn, reflux, GERD	5,748	12.7%	13,346	12.9%	143,469	6.4%
Headache	5,119	11.3%	12,928	12.5%	117,204	5.3%
Otitis media	4,980	11.0%	10,287	10.0%	196,258	8.8%
Food allergy^a	4,503	9.9%	9,181	8.9%	20,955	0.9%
Bronchitis	4,347	9.6%	9,851	9.5%	116,626	5.2%
Atopic dermatitis	3,715	8.2%	7,324	7.1%	59,502	2.7%
Depression	3,628	8.0%	9,473	9.2%	126,999	5.7%
Eczema	3,469	7.7%	7,517	7.3%	83,330	3.7%
Sleep apnea	3,365	7.4%	7,662	7.4%	82,031	3.7%
Eustachian tube disorder	3,162	7.0%	6,660	6.5%	49,032	2.2%
Skin rash (including pruritus)	2,634	5.8%	6,488	6.3%	72,505	3.2%
Sleep disturbance^b	2,594	5.7%	6,682	6.5%	79,540	3.6%
Migraine	2,428	5.4%	6,243	6.0%	61,997	2.8%
Pneumonia	1,313	2.9%	2,754	2.7%	39,751	1.8%
Nasal polyps	1,295	2.9%	2,685	2.6%	4,970	0.2%
Chronic tonsillitis	414	0.9%	985	1.0%	7,387	0.3%
Concomitant Therapy (N, %)
Nasal spray	23,653	52.2%	45,766	44.3%	246,566	11.1%
Intranasal corticosteroid	19,435	42.9%	38,058	36.9%	251,121	11.3%
Decongestant	13,626	30.1%	29,796	28.9%	139,088	6.2%
Antihistamine	8,155	18.0%	17,371	16.8%	105,286	4.7%
Surgical Procedures^c (N, %)	2,030	4.5%	4,239	4.1%	20,195	0.9%

^a Food allergy includes peanuts, milk and milk produces, eggs, seafoods, and adverse symptoms related to food contact.

^b Sleep disturbance includes insomnia, hypersomnia, circadian rhythm sleep disorders, and narcolepsy.

^c Surgical procedures include turbinectomy, endoscopic sinus surgery, septoplasty, tympanostomy, and nasal polypectomy.

Abbreviations. AIT, allergy immunotherapy; GERD, gastroesophageal reflux disease; SD, standard deviation.

Table 3. All-cause and AR-related healthcare costs by AIT cohorts in the baseline and follow-up periods.

	25+ AIT FILLS		ANY AIT FILLS		NO AIT FILLS
	N = 45,279		N = 103,207		N =2,231,323
	N/Mean	%/SD	N/Mean	%/SD	N/Mean	%/SD
All-Cause Costs^a
Pre-Index Period
Inpatient costs	$799	$6,815	$1,091	$9,926	$981	$11,811
ER costs	$324	$1,095	$432	$1,517	$275	$1,244
Physician office visit costs	$1,004	$780	$981	$993	$480	$616
Specialist office visit costs	$260	$237	$212	$237	$20	$86
Laboratory costs	$399	$1,459	$520	$2,397	$257	$1,292
Other outpatient costs	$3,823	$9,410	$4,170	$11,955	$2,075	$10,150
Outpatient prescription costs	$2,098	$5,727	$2,222	$6,873	$1,145	$6,123
Total Medical Costs (Mean, SD)	$6,349	$13,551	$7,195	$18,270	$4,069	$17,780
Total Healthcare Costs (Mean, SD)	$8,447	$15,467	$9,418	$20,566	$5,213	$19,503
Follow-Up Period
Inpatient costs	$698	$7,248	$1,281	$12,991	$1,426	$16,790
ER costs	$288	$1,079	$416	$1,573	$370	$1,615
Physician office visit costs	$903	$802	$898	$1,140	$760	$731
Specialist office visit costs	$202	$259	$156	$258	$71	$166
Laboratory costs	$355	$1,047	$490	$2,433	$380	$1,606
Other outpatient costs	$5,706	$9,478	$5,905	$13,539	$3,180	$13,769
Outpatient prescription costs	$2,480	$7,198	$2,622	$8,674	$1,699	$8,529
Total Medical Costs (Mean, SD)	$7,950	$13,844	$8,989	$22,019	$6,116	$24,692
Total Healthcare Costs (Mean, SD)	$10,431	$16,606	$11,612	$24,797	$7,815	$27,041
AR-Related
Pre-Index Period
Inpatient costs	$66	$1,286	$76	$1,577	$29	$1,115
ER costs	$96	$513	$125	$687	$61	$434
Physician office visit costs	$515	$405	$455	$423	$126	$223
Specialist office visit costs^b	$240	$217	$192	$216	$12	$63
Laboratory costs	$10	$189	$9	$166	$3	$85
Other outpatient costs	$1,312	$3,748	$1,254	$3,875	$200	$1,579
Outpatient prescription costs	$617	$1,377	$563	$1,807	$101	$535
Surgical procedure costs^c	$295	$2,339	$271	$2,168	$32	$603
Anaphylaxis costs	$0	$0	$0	$0	$0	$0
Total Medical Costs (Mean, SD)	$1,998	$4,283	$1,919	$4,568	$417	$2,132
Total Healthcare Costs (Mean, SD)	$2,615	$4,668	$2,482	$5,118	$518	$2,252
Follow-Up Period
Inpatient costs	$22	$763	$43	$1,043	$35	$1,405
ER costs	$74	$458	$107	$671	$88	$561
Physician office visit costs	$410	$431	$363	$429	$322	$317
Specialist office visit costs	$188	$244	$141	$237	$60	$146
Laboratory costs	$4	$81	$6	$136	$5	$145
Other outpatient costs	$3,054	$3,855	$2,747	$4,663	$528	$2,749
Outpatient prescription costs	$816	$2,119	$749	$2,544	$218	$992
Surgical procedure costs	$280	$2,136	$271	$2,145	$104	$1,233
Anaphylaxis costs	$6	$90	$5	$99	$0	$0
AIT costs	$2,150	$1,205	$1,798	$1,805	$0	$0
Total Medical Costs (Mean, SD)	$3,564	$4,163	$3,266	$5,091	$978	$3,352
Total Healthcare Costs (Mean, SD)	$4,380	$4,909	$4,015	$5,950	$1,195	$3,597

^a Costs were calculated based on paid amounts of adjudicated claims, including insurer and health plan payments, and patient cost-sharing in the form of copayment, deductible, and coinsurance. All costs were adjusted for inflation using the medical care component of the Consumer Price Index (CPI) and standardized to 2018 U.S. dollars.

^b Specialist office visits include allergy, immunology, otolaryngology, or pulmonary disease providers.

^c Surgical procedures include turbinectomy, endoscopic sinus surgery, septoplasty, tympanostomy, and nasal polypectomy.

Abbreviations. AIT, allergy immunotherapy; ER, emergency room; SD, standard deviation.

Figure 1. All-cause and AR-related cost differences baseline to follow-up by AIT cohorts.

Figure 2. Cost distribution of index SCIT claims by select Current Procedural Terminology codes.