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Health Care Costs and Financing

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Allergic rhinitis care costs have soared in the past decade due to newer antihistamines and other medications

The direct costs of allergic rhinitis have increased substantially since the introduction of second-generation antihistamines and intranasal corticosteroids as first-line treatment for the problem. Annual direct costs for allergic rhinitis nearly tripled, from $1.23 billion in 1987 to $3.4 billion in 1996, according to a study conducted by researchers at the Duke Clinical Research Institute and Duke University Medical Center. Their work was supported in part by the Agency for Healthcare Research and Quality (Centers for Education and Research on Therapeutics cooperative agreement HS10385).

Nearly 8 percent of the U.S. population suffered from allergic rhinitis in 1996. The researchers analyzed resource use and costs for allergic rhinitis based on 1996 data from AHRQ's Medical Expenditure Panel Survey and found that the majority of direct medical costs for the problem were for prescription medications (47 percent) and outpatient visits (52 percent). Over half (51 percent) of the money spent for prescriptions was for second-generation antihistamines, 25 percent was for intranasal corticosteroids, and 5 percent was for first-generation antihistamines. Costs for outpatient physician visits for patients receiving immunotherapy were $524 per year compared with $42 per year for patients not receiving immunotherapy.

Overall, 58 percent of patients with allergic rhinitis received one or more prescription drugs to treat the condition during the study year. Among these patients, the mean prescription expenditures were $131, including $50 in out-of-pocket expenditures. However, insurance type made a difference. The mean prescription medication expenditure for Medicaid-insured individuals was $103, $155 for those with private insurance, $213 for those with other insurance, and $69 for individuals who had no prescription drug coverage, who also paid more out of pocket than those who were insured.

It is assumed that the increased expenditures for nonsedating antihistamines will be offset by the impact of symptom control on workforce productivity and the resulting increase in the Gross National Product (GDP). Lack of sedation with these drugs, compared with older sedating antihistamines, is expected to be seen in fewer accidents resulting in deaths or injuries. An analysis to test these assumptions is needed, conclude the authors.

More details are in "Direct costs of allergic rhinitis in the United States: Estimates from the 1996 Medical Expenditure Panel Survey," by Amy W. Law, Pharm.D., Shelby D. Reed, Ph.D., John S. Sundy, M.D., Ph.D., and Kevin A. Schulman, M.D., in the February 2003 Journal of Allergy and Clinical Immunology 111, pp. 296-300.

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