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BACKGROUND: Allergic asthma causes substantial morbidity and constitutes a public health burden, which increases with asthma severity. There is evidence that allergy immunotherapy (AIT) prevents the progression of allergic rhinitis (AR) to asthma. However, evidence is missing on the potential of AIT to prevent progression from milder to more severe asthma. METHODS: This population-based cohort study utilized healthcare data (2005 to 2014) from a statutory health insurance in Germany. The severity of asthma was classified according to the treatment steps recommended by the global initiative for asthma (GINA). The effect of AIT on the transition between the GINA steps was analyzed using multivariable Cox regression models adjusted for age and sex. RESULTS: From the total cohort of 1,739,440 patients, 39,167 individuals aged 14 years or older were classified as having incident asthma during the observation period and were included in the study. From these, 4111 patients (10.5%) received AIT. AIT exposure was associated with a significantly decreased likelihood of asthma progression from GINA step 1 to GINA step 3 (HR 0.87; 95% CI 0.80-0.95) and GINA step 3 to GINA step 4 (HR 0.66; 95% CI 0.60-0.74). GINA medication for step 2 and step 5 was rarely prescribed. CONCLUSIONS: This observational study in a real-world setting indicates that patients with allergic asthma who receive AIT are less likely to experience progression of asthma severity than asthma patients not receiving AIT.

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BACKGROUND: Allergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent comorbidity. Allergy immunotherapy (AIT) is the only causal therapy of AR and AA, and can be administered as subcutaneous injections at the physician or as sublingual drops or tablets at home. The usual treatment duration is 3 years. OBJECTIVE: This study aimed to elicit patient preferences to identify the AIT administration mode preferred by patients. METHODS: A discrete-choice-experiment (DCE) was developed to determine how people weight different treatment options using a paper-based questionnaire from June to September 2014, including 16 study centres. Main inclusion criteria: >18 years, grass, birch and/or house dust mite AR with moderate to severe symptoms, AIT-naïve and AIT-indicated. DCE-attributes were: Administration form, number and duration of physician visits, frequency of life-threatening anaphylactic shocks, local side-effects and co-payments. RESULTS: Two-hundred thirty-nine subjects participated, resulting in analysable 1842 choices. All attributes were significant predictors for the treatment-choice. Ranked by importance, the following first three attributes are most preferred by patients: 1(st) Number and duration of physician visits: Fewer visits with shorter duration preferred (0.658*) 2(nd) Frequency of life-threatening anaphylactic shocks: Lower risk of shocks preferred (0.285*) 3(rd) Local side-effects: Preference for rash/swelling on upper arm over itching/swelling under the tongue (0.210*) (*coefficient-size represents relative importance of the attributes) CONCLUSION: The most important attribute is the number and duration of visits to a physician. A lower risk of life-threatening anaphylactic shocks was ranked as the second whereas co-payments and administration form play a limited role.

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OBJECTIVE: To project the future costs of primary care providers in Denmark, taking into account high costs in the last year of life. DESIGN: Observational study and modelling. SETTING: Primary health care providers (doctors, dentists, physiotherapists, etc.), but not nursing homes and home help services. METHODS: The Danish population for the years 1995-2020 was projected on the basis of the current population using the cohort-component method. Average costs of use of various types of primary care providers were estimated from a 19.2% random sample of the 1995 population. Future costs were then projected using the population projection and age- and sex-specific average costs for survivors and non-survivors. RESULTS: The population was projected to increase by 8.2%, while the estimated increase was 36.1% for people aged over 50 years. Future costs of primary care providers were projected to increase by 8.2%, i.e. proportionally to the population increase. CONCLUSIONS: The results of the study indicate that demographic changes will Influence future costs of primary care providers through an increasing population size, but not because of ageing. This conclusion is independent of whether high costs in the last year of life are accounted for or not.

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While some studies have shown a considerable effect of ageing upon future health care costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in health care costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care and primary health care services in Denmark on the basis of demographic changes, both with and without account for the high costs in the last year of life. Costs were projected on the basis of a random 19% sample of the Danish population using the cohort-component method. The traditional projection method does not account for the high costs in the last year of life while the 'improved' method does. The Danish population was projected to increase by 8.2% during the period 1995-2020, and health care costs by 18.5% according to the traditional projection method and 15.1% according to the improved one. These results suggest that the high costs in the last year of life does matter in projections of future health care costs and should be taken into account. Furthermore, ageing per se seems to have considerable impact on future health care costs.

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