Current medical health care reimbursements in the United States have evolved from a loosely controlled, fee-for-service system into highly regulated, managed care organizations. Physicians, patients, employers, insurance providers, and local and federal government health agencies have developed a heightened awareness of increasing health care costs in this country and of the responsible driving forces. The discipline of pharmacoeconomics is an important means for assessing the cost versus benefit of medical diagnostic procedures and therapeutic interventions. Pharmacoeconomic studies have been conducted for potential new therapeutic agents, educational programs, and diagnostic or screening procedures in almost every medical and surgical subspecialty. The modification of standard health care protocols is influenced by the demonstration that a drug, educational program or diagnostic/screening procedure improves short- and long-term medical outcomes and quality of life in a cost-effective manner. Medical specialty organizations have developed practice parameters that define consensus state-of-the-art approaches to specific clinical disorders. Whenever possible, these guidelines have incorporated pharmacoeconomic data that support current recommendations.

Pharmacoeconomics has already affected the specialty of allergy and clinical immunology. For example, the design of new investigational drug protocols for the treatment of allergic rhinitis and asthma now frequently include quality-of-life questionnaires.<sup>23 Juniper E.F., Guyatt G.H. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis Clin Exp Allergy 1991 ;  21 : 77-83  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> These protocols also often monitor changes in end-point parameters such as days lost from school and work, which have previously been demonstrated to correlate with the indirect costs associated with specific disease management.<sup>24 Juniper E.F., Guyatt G.H., Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: Development and testing a questionnaire for clinical trials J Allergy Clin Immunol 1994 ;  93 : 413-423  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Another example of the impact of pharmacoeconomics is the development of asthma self-management programs, which are cost-effective in reducing asthma morbidity.<sup>27 Kotses H., Bernstein I.L., Bernstein D.I. , e al. A self-management program for adult asthma: Part I: Development and evaluation J Allergy Clin Immunol 1995 ;  95 : 529-540  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 45 Taitel M.S., Kotses H., Bernstein I.L. , e al. A self-management program for adult asthma. Part II: Cost-benefit analysis J Allergy Clin Immunol 1995 ;  95 : 672-676  [cross-ref]

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There are no well-controlled pharmacoeconomic studies assessing the benefits of allergen immunotherapy in the treatment of allergic rhinitis or allergic asthma. An increased amount of direct and indirect information, however, supports the cost-effectiveness of allergen immunotherapy. Allergen immunotherapy should be scrutinized because it is widely prescribed and constitutes a significant percentage of the total health care costs attributed to the treatment of allergic rhinitis and asthma.