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

Background: 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. Methods: 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. Results: 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. Conclusions: This study showed that Azelastine/Fluticasone combination was the cost saving alternative