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A CLOSER LOOK AT

Allergies are the sixth leading


cause of chronic disease in the
United States, and cost the
health care system over $18
billion annually.

A JOINT PROJECT BETWEEN


T H E A S T H M A A N D A L L E R G Y F O U N DAT I O N O F A M E R I C A A N D
T H E N AT I O N A L P H A R M AC E U T I C A L C O U N C I L
A n allergy is an inappropriate reaction by your immune
system to harmless substances.1 These substances can
trigger sneezing, wheezing, coughing,
antihistamines (widely available over the counter), which
have been shown to cause irritability, insomnia, anxiety,
depression, dry mouth, and drowsiness.
itching and severe, potentially fatal
reactions.2 Allergens enter the body in The growing prevalence of allergies highlights the
several ways. Airborne particles such importance of practice guidelines for their diagnosis and
as pollen, dust and mold spores are treatment.5 AAAAI, the National Institute of Allergy and
breathed in through the nose and Infectious Diseases (NIAID), and 20 other medical
mouth; insect venom is injected associations, advocacy groups, and government agencies
through stingers; foods are ingested or recently published a report illustrating the best practices in
swallowed. Medicines that can cause the treatment of allergic disorders. Treatment
allergic reactions are injected or recommendations include avoiding allergic triggers and
ingested. Many people suffer using less-sedating or non-sedating antihistamines, or nasal
needlessly from allergies because they sprays.3 Non-sedating antihistamine-decongestant
have never sought medical diagnosis or combinations are recommended by the AAAAI for patients
cannot identify the specific allergen.1 with heavy congestion, and have been shown to reduce
However, with proper management and asthma symptoms among people diagnosed with both
patient education, allergies can be allergies and asthma.6 The Joint Task Force on Practice
controlled and people with allergies Parameters in Allergy, Asthma and Immunology also states
can lead normal and productive lives.2 in its guidelines that non-sedating antihistamines should
be considered before sedating antihistamines because they
Allergies and related conditions, such cause fewer side effects.7
as asthma, are becoming more common
and can be seasonal or yearlong. The From an employer’s perspective, these therapies appear to
American Academy of Allergy, Asthma, be cost saving. The relatively high numbers of people who
and Immunology (AAAAI) estimates suffer from allergies and the lost productivity associated
that allergies are the sixth leading with them make allergies one of the most expensive
cause of chronic disease in the United diseases for employers. However, estimates suggest that
States, and cost the health care system over $18 billion employers can save $2 to $4 for each $1 spent to increase
annually.3 More than 50 million Americans—about one of the use of non-sedating rather than sedating
every five adults and children—suffer from allergies, antihistamines.8 The risk of workplace injury, for example,
including allergic asthma.3 Long regarded as trivial, patients is significantly higher among workers taking sedating
and physicians are now beginning to realize that allergies antihistamines. Productivity is also reduced when workers
are serious disorders that may demand advice from a use sedating antihistamines. According to one study, if 50
physician. Furthermore, over-the-counter treatments may percent of workers treated for allergies use sedating
prove less effective and have more side effects when antihistamines and therefore functioned at 75 percent
addressing allergic disorders.1 efficiency, the estimated lost productivity cost would be
$2.4 billion for men and $1.4 billion for women. The
A number of diseases can appear to be allergies, but upon estimated cost of lost workdays would be an additional
professional examination prove to have other causes. For $108 million.9
example, a runny nose and nasal congestion can be a result
of chronic and repeated infections, but can appear similar
to allergies. However, it is important to show proof of
allergy whenever it is suspected because the treatments for
allergic and non-allergic disease can be quite different.2
Treating allergies requires avoiding allergic triggers, drug
therapy to relieve and prevent chronic symptoms, and in
severe cases, allergy shots to desensitize the patient to
specific allergic triggers. Oral antihistamines and nasal
sprays are the primary forms of drug therapy. Although
nasal sprays have been shown to be effective,
antihistamines remain the main drug treatment for
allergies.3, 4 Newer, second-generation antihistamines
(currently only available by prescription) provide relief
with fewer side effects than first-generation sedating
I
n addition to direct medical costs of $4.5 billion per Data from the 1987 National Medical Expenditure Survey
year for the treatment of allergies, there are also suggests that:11
indirect costs associated with allergies due to • Americans miss 811,000 days of work due to allergies;
absenteeism and reduced productivity from the sedating • Americans miss 824,000 days of school due to allergies;
effects of older drugs used in treatment.3, 10 and,
• Americans have 4.2 million days of reduced activity per
year due to allergies.

More recently, a 1999 report from the American Academy


of Allergy, Asthma, and Immunology (AAAAI) estimates 3.8
million lost work and school days due to allergies.3

E
MPLOYERS CAN SAVE
$2 TO $4 FOR EACH
$1 SPENT TO
INCREASE THE USE OF
NON-SEDATING RATHER
THAN SEDATING
ANTIHISTAMINES.

Like baldness, height and eye color, the capacity to become allergic can be an inherited characteristic.2 If one parent has
allergies, there is a 50 percent chance their children will have an allergy. If both parents have allergies, it is much more
likely (66 percent) that their children will have allergies.3 Yet a genetic predisposition to allergies does not necessarily
mean allergic sensitivity. Developing allergic sensitivity is dependent on genetics, exposure to one or more allergens to
which there is a genetically programmed response, and the degree and length of exposure. Other allergic reactions, such
as those produced by many plants, dyes, metals, and chemicals in deodorants and cosmetics, have no genetic basis.2
Some examples of allergens by route of exposure.3

Inhaled Allergens Contact Allergens Ingested Allergens


Pollens Plants Foods
Molds/fungi Drugs Drugs
House dust mites Cosmetics
Animal danders Jewelry (e.g., nickel)
Cockroaches Latex products
Latex particles Occupational chemicals/dyes

A
MERICANS SPEND $4.5 BILLION EACH YEAR
TREATING ALLERGIES.

A CLOSER LOOK AT SPENDING FOR


ALLERGY MEDICATIONS
Spending on pharmaceuticals was analyzed for individuals who received health benefit
coverage from large employers in 1994 and 1997. The sample included individuals who were
diagnosed with allergies or conditions for which allergy medicines are often prescribed. A
similar analysis was conducted for individuals enrolled in private managed care plans from
1997 to 1999.

FACTORS INFLUENCING DRUG SPENDING


FOR ALLERGIES 1994-1997 Price
Factors
Spending for allergy medications rose 67 percent from 1994 to 1997. Volume factors
(increased numbers of people with allergies receiving antihistamines and allergy- Volume
related prescriptions, and increased intensity and duration of drug therapy) accounted Factors
for roughly four-fifths of the total increase. Price factors had a relatively modest impact
on spending growth.

Factors Influencing Growth in Rx Expenditures: % Positive Impact % Negative Impact


Total Growth in Expenditures +67
Growth Due to Volume Factors +53
Changes in the Number of Prescriptions per Person for Established Drugs -38
Changes in the Number of Prescriptions per Person for New Entrants +48
Changes in Days of Therapy for Established Drugs + 13
Changes in Days of Therapy for New Entrants +1
Patients per 1000 Health Care Enrollees +28
Growth Due to Price Factors +14
Inflation +6
Changes in Mix of Established Drugs +8
Price of New Entrants +0.1
Source: MEDSTAT’s Marketscan database
FACTORS INFLUENCING DRUG SPENDING FOR
Price
ALLERGIES 1997-1999 Factors

Spending for allergy medications rose 89 percent between 1997 and 1999. Again, volume
factors (increased numbers of people with allergies receiving antihistamines and allergy-
related prescriptions, and increased intensity and duration of drug therapy) accounted for Volume
the majority of the increase. Increased numbers of patients being treated alone accounted Factors
for nearly half of the overall increase in spending.

Factors Influencing Growth in Rx Expenditures: % Positive Impact % Negative Impact


Total Growth in Expenditures +89
Growth Due to Volume Factors +77
Changes in the Number of Prescriptions per Person for Established Drugs +0.1
Changes in the Number of Prescriptions per Person for New Entrants +21
Changes in Days of Therapy for Established Drugs + 15
Changes in Days of Therapy for New Entrants +0.6
Patients per 1000 +40
Growth Due to Price Factors +11
Inflation +8
Changes in Mix of Established Drugs -0.4
Price of New Entrants +4
Source: Protocare Sciences managed care database

METHODOLOGY
This study separately analyzed prescription drug
spending growth for two large national claims databases,
one representing managed care plan enrollees and the
other representing those covered by large employer-
provided health benefit plans. The study defined and
assessed several factors affecting the price per day of
therapy and the volume of therapy — the number of
days of therapy received and the number of patients
receiving drug therapy. The analysis also examined the
effects of price and volume changes for established drugs
on the market during the entire period of analysis and for
new drugs that were first marketed during this period.
ABOUT THIS
FOR MORE INFORMATION ABOUT ALLERGIES,
PUBLICATION: PLEASE CONTACT:
“A Closer Look at Allergies” is a joint Asthma and Allergy Foundation of America (AAFA)
publication of the Asthma and Allergy www.aafa.org
Foundation of America and the National 1-800-7-ASTHMA
Pharmaceutical Council.
American Academy of Allergy, Asthma and Immunology (AAAAI)
The Asthma and Allergy Foundation of www.aaaai.org
America (AAFA) is the premier patient 1-800-822-2762
organization dedicated to improving the
quality of life for people with asthma American College of Allergy, Asthma and Immunology (ACAAI)
and allergies, and their families through www.allergy.mcg.edu
education, advocacy and research. 1-800-842-7777
AAFA, a not-for-profit organization
founded in 1953, provides practical National Centers for Disease Control and Prevention (CDC)
information, community based services, www.cdc.gov
support and referrals through a national 1-800-CDC-1311
network of chapters and educational
support groups. AAFA also raises funds National Institute of Allergy and Infectious Diseases (NIAID)
for asthma care and research. National Institutes of Health/
Office of Communications and Public Liaison
Since 1953, the National Pharmaceutical www.niaid.nih.gov
Council (NPC) has sponsored and 301-496-5717
conducted scientific, evidence-based
analyses of the appropriate use of
pharmaceuticals and the clinical and
economic value of pharmaceutical
innovation. NPC provides educational
resources to a variety of health care
stakeholders, including patients, clinicians,
payers and policy makers. More than 20
research-based pharmaceutical companies
are members of the NPC.
1
Ulene, Art and the Asthma and Allergy Foundation 7
Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R,
of America. How to Outsmart Your Allergies. New Blessing-Morre J, Li JT, Bernstein IL, Berger W, Spector S,
York: HealthPOINTS, 1998. Schuller D. Diagnosis and management of rhinitis:
Complete guidelines of the Joint Task Force on practice
2
The Asthma and Allergy Foundation of America. parameters in allergy, asthma, and immunology. Ann
What are Allergies? Asthma and Allergy Answers. Allergy Asthma Immunol 1998:478-518.
1999.
8
Measuring the value of the pharmacy benefit:
3
American Academy of Allergy Asthma and Allergy as a case example. William M. Mercer, Inc.
Immunology (AAAAI). The Allergy Report. 2000.
Milwaukee, WI: AAAAI, 2000.
9
Fireman P. Treatment of allergic rhinitis: Effect on
4
Weiner JM, Abramson MJ, Puy RM. Intranasal occupation productivity and work force costs. Allergy
corticosteroids versus oral H1 receptor antagonists in and Asthma Proc 1997,18(2):63-67.
allergic rhinitis: systematic review of randomised
For more information about NPC or for controlled trials. BMJ 1998;317(7173):1624-1629. Meltzer EO, Grant JA. Impact of cetirizine on the
10

additional resources, please contact: burden of allergic rhinitis. Ann Allergy Asthma
5
Rachelefsky GS. National guidelines needed to Immunol 1999;83(5):455-463.
The National Pharmaceutical Council manage rhinitis and prevent complications. Annals of
1894 Preston White Drive Allergy, Asthma, & Immunology 1999;82:296-305. 11
Malone DC, Lawson KA, Smith DH, Arrighi HM,
Reston, VA 20191-5433 Battista C. A cost of illness study of allergic rhinitis in
6
Corren J, Harris A, Aaronson D, et al. Efficacy and the United States. J Allergy Clin Immunol 1997:22-27.
safety of loratadine plus pseudoephedrine in patients
Phone: 703-620-6390 with seasonal allergic rhinitis and mild asthma. J Allergy
Fax: 703-476-0904 Clin Immunol 1997;100:781-788.
www.npcnow.org