Health economic evaluation of intranasal olopatadine compared with fluticasone furoate nasal spray for allergic rhinitis

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Background Allergic rhinitis (AR) is a common immunoglobulin E–mediated inflammatory disease that substantially impairs quality of life and imposes considerable healthcare and societal costs. In Thailand, optimizing treatment strategies for AR is essential to ensure efficient healthcare resource allocation. While intranasal corticosteroids are recommended as first-line therapy for moderate-to-severe AR, antihistamine-based intranasal agents such as olopatadine have been proposed for early allergic inflammation control. However, the comparative economic value of these treatments within the Thai health technology assessment (HTA) framework remains insufficiently evaluated. This study assessed the cost-effectiveness and cost-utility of intranasal olopatadine (INOP) compared with fluticasone furoate nasal spray (FFNS) in patients with allergic rhinitis. Methods A model-based pharmacoeconomic evaluation was conducted using a decision-tree model with a one-year time horizon from a societal perspective. Both cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were performed in accordance with ISPOR methodological recommendations and CHEERS 2022 reporting standards. Clinical effectiveness was measured using absolute risk reduction (ARR) in symptom improvement. Health-related quality of life was assessed using the Rhinoconjunctivitis Quality of Life Questionnaire and mapped to EQ-5D-3L utility values to estimate quality-adjusted life years (QALYs). Cost components included direct medical, direct non-medical, and indirect productivity costs. Sensitivity analyses, including deterministic one-way analysis and probabilistic Monte Carlo simulation (1,000 iterations), were conducted to assess uncertainty. Results INOP generated higher annual costs (10,271.90 THB) than FFNS (9,330.08 THB) and demonstrated lower effectiveness (ARR difference −0.31). Cost-utility analysis showed lower QALYs for INOP (0.74) compared with FFNS (0.83). Consequently, INOP was economically dominated by FFNS. Sensitivity analyses confirmed the robustness of the findings, with most probabilistic simulations indicating that INOP remained more costly and less effective. Conclusion Fluticasone furoate nasal spray represents a clinically superior and economically dominant strategy for allergic rhinitis management in Thailand, supporting its prioritization in clinical practice and HTA-based healthcare decision-making.

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Related topics: Allergic Rhinitis and Sensitization · Health Systems, Economic Evaluations, Quality of Life · Asthma and respiratory diseases