Mapping naso-ocular symptom scores to EQ-5D-5L utility values in Japanese cedar pollinosis

Hiroshi Kumanomidou; Kengo Kanai; Aiko Oka; Takenori Haruna; Yuji Hirata; Sei-Ichiro Makihara; Takaya Higaki; Maki Akamatsu; Yoshitaka Okamoto; Shunya Ikeda; Mitsuhiro Okano

doi:10.1016/j.alit.2021.11.002

Mapping naso-ocular symptom scores to EQ-5D-5L utility values in Japanese cedar pollinosis

Allergol Int. 2022 Apr;71(2):207-213. doi: 10.1016/j.alit.2021.11.002. Epub 2021 Dec 3.

Authors

Affiliations

¹ Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan; Kumanomidou ENT Clinic, Tokyo, Japan.
² Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan.
³ Department of Otorhinolaryngology-Head & Neck Surgery, Himeji St. Mary's Hospital, Himeji, Japan.
⁴ Department of Otorhinolaryngology-Head & Neck Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
⁵ Department of Otorhinolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan.
⁶ Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
⁷ Chiba Rosai Hospital, Ichihara, Japan.
⁸ Department of Public Health, International University of Health and Welfare School of Medicine, Narita, Japan.
⁹ Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan; Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: mokano@iuhw.ac.jp.

PMID: 34872827
DOI: 10.1016/j.alit.2021.11.002

Abstract

Background: The total naso-ocular symptom score (TSS) is widely used as an endpoint to evaluate the severity of seasonal allergic rhinitis. However, it is not a generic preference-based measure. We sought to develop an algorithm for mapping between the TSS and health utility in Japanese cedar pollinosis (JCP). We also performed a cost-utility analysis of sublingual immunotherapy (SLIT) for JCP by using this algorithm.

Methods: Patients with JCP filled out the TSS questionnaire and EQ-5D-5L simultaneously during the pollen season in 2019 and in 2020. We estimated a direct utility mapping model by regressing responses to individual TSS questions directly onto utility. The incremental cost-effectiveness ratio (ICER) of active SLIT to a placebo was determined by examining the drug expense and the estimated quality-adjusted life year (QALY) using a dataset from a double-blind placebo-controlled clinical trial.

Results: A total of 238 records were included for analysis. The estimated utility decreased with increasing severity of rhinitis. Patients with comorbid asthma showed lower utility. A negative and significant correlation was seen between the TSS and utility in both 2019 and 2020. The estimated equations were: Y(utility) = -0.0161∗X(TSS) + 1.005 in non-asthmatic JCP patients. The ICER of active SLIT to the placebo was estimated to be 4,049,720 and 6,011,218 JPY/QALY in the first and second year, respectively.

Conclusions: It is possible to reasonably predict utility from the total naso-ocular symptom score by using regression models. In the estimated algorithm, pre-seasonal SLIT for JCP is cost-effective.

Keywords: Allergic rhinitis; EQ-5D-5L; Mapping; QALY; Symptom score.

MeSH terms

Allergens / therapeutic use
Cryptomeria
Humans
Pollen
Rhinitis, Allergic, Seasonal* / drug therapy
Rhinitis, Allergic, Seasonal* / therapy
Sublingual Immunotherapy*

Substances

Allergens