DOI: 10.1097/01.MLR.0000100584.18276.C4
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PMID: 14668671
Issn Print: 0025-7079
Publication Date: 2003/12/01
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Abstract
Background.A U.S. Food and Drug Administration advisory committee deemed the second-generation antihistamines (SGA) safe for over-the-counter use against the preliminary opposition of the manufacturers. As a result, loratadine is now available over-the-counter. First-generation antihistamines (FGA) are associated with an increased risk of unintentional injuries, fatalities, and reduced productivity. Access to SGA over-the-counter could result in decreased use of FGA, thereby reducing deleterious outcomes. The societal impact of transitioning this class of medications from prescription to over-the-counter status has important policy implications.
Objective.To examine the cost-effectiveness of transitioning SGA to over-the-counter status from a societal perspective.
Research Design.A simulation model of the decision to transition SGA to over-the-counter status was compared with retaining prescription-only status for a hypothetical cohort of individuals with allergic rhinitis in the United States. Estimates of costs and effectiveness were obtained from the medical literature and national surveys. Sensitivity analysis was performed using a second-order Monte Carlo simulation.
Main Outcome Measures.Discounted, quality-adjusted life-years saved as a result of amelioration of allergic rhinitis symptoms and avoidance of motor vehicle, occupational, public and home injuries and fatalities; discounted direct and indirect costs.
Results.Availability of SGA over-the-counter was associated with annual savings of $4 billion ($2.4–5.3 billion) or $100 ($64–137) per allergic rhinitis sufferer and 135,061 time-discounted quality-adjusted life years (84,913–191,802). The sensitivity analysis provides evidence in support of these results.
Conclusion.Making SGA available over-the-counter is both cost-saving and more effective for society, largely as a result of reduced adverse outcomes associated with FGA-induced sedation. Further study is needed to determine the differential impact on specific vulnerable populations.
