A cost minimization analysis of Azelastine/Fluticasone combination nasal spray versus Azelastine and Fluticasone nasal sprays monotherapy in moderate to severe allergic rhinitis in Iran

Allergic Rhinitis (AR) is a symptomatic disorder which is due to allergen exposure and IgE inflammatory pathway activation in respiratory tract. The present study’s purpose was to assess Azelastine/Fluticasone combination nasal spray cost-effectiveness in comparison with Azelastine and Fluticasone nasal sprays monotherapy, in mild to moderate AR patients in Islamic Republic of Iran (I.R.I.) health care system. A literature review was performed in order to compare the effectiveness of Fluticasone/Azelastine (50μg/125μg) with Fluticasone (50μg) and Azelastine (125μg). The search was conducted in PubMed, ISI, Scopus, Cochrane, CRD York and Google Scholar based on a predefined PICO of the study. According to confirmed equal clinical effectiveness of two arms, a cost minimization analysis was done. As micro costing, direct medical costs (drugs` costs, GP office visits, office visit and allergy-related tests), based on official tariffs in Iran were calculated in a 14-day time horizon. Because of model’s time horizon, which was less than 1 year, discount rate was not applied. The result of literature search were two RCTs in which the combination form had been compared with each of the spray of Azalastine and Fluticasone. Azelastine/Fluticasone would save 2.05$ per patient for each course of treatment; and therefore recognized as cost-effective. This study showed that Azelastine/Fluticasone combination was the cost saving alternative