The prominence of allergic rhinitis continues to increase in India, with proven data from International study of asthma and allergies in childhood (ISSAC) studies. Phase 1 conducted in 1998, reported a prevalence rate of 12.5% – 18.6% among children, which rose to 12.9%-23.6% in 2009 Phase-3 results. The patients are classifiable into two clinical groups on the basis of clinical profile they present, sneezers and runners and blockers. The blockers form a higher proportion of rhinitis population, with high persistence of moderate to severe rhinitis. The discussion here undertakes the comparative analysis for India and USA, depicting the stance in developing and developed regions.
Global burden of rhinitis
Like any other allergic disease, allergic rhinitis exerts significant direct, indirect and intangible costs on the society. The economic burden posed by this allergy varies across different regions. Hellgren et al. (2010), obtained results from 1213 adults in Sweden, to observe the economic burden of allergic rhinitis. The disease resulted in productivity losses of €653 per person per year, with total productivity loss of € 2.7 billion a year. Furthermore, the total cost for allergic rhinitis in South Korea amounts to US$266 million (Pawankar et al. 2011).
Another study on the Swedish population reported the annual allergic rhinitis burden as €1.3 billion. The mean annual direct cost was €210.3 and the indirect cost was €750.8. Also, the per patient per year cost was €961.1 (Cardell et al., 2016). Colas et al. (2017) recruited a small size of 498 patients, to calculate the costs of allergic rhinitis in Spain. The findings showed the per patient per year direct costs as €553.80 and indirect costs were €1772.90. However, the assessment of the economic burden for other regions across the globe is not prominent.
Economic burden of rhinitis in India
There is a lack of culminated information on analyzing rhinitis economic burden in India. Thus, accurate countrywide estimation is hard to achieve. Singh & Kumar (2016) present a cost analysis of second-generation drugs prescribed in India. The analysis of 8 drugs manufactured by a number of companies revealed that Fexofenadine to be the costliest at INR 123.56. On the other hand, levocetirizine was the cheapest at INR 2.3. Surprisingly, for cetirizine, a maximum price variation of 4300% amongst different brands was recorded.
This is worrisome as both National List of Essential Medicines (2015) and DPCO 2013 list of controlled drugs and formulations list this drug. Another study by Chauhan &Khokar (2015) paid attention to the quality of life of rhinitis patients by drawing data from hospitals in Hardwar. A study of 200 patients using WHOQOL tool, revealed limitations in almost all daily activities, mood and cognitive behavior. The patients reflected low physical activity, low self-esteem and negative feeling, although independent of gender and age.
Sharma et al. (2015) analyzed the quality of life from a clinical perspective utilizing a small sample size of 40 patients visiting the outpatient department of Gian Sagar Medical College and Hospital, Patiala. Males reported poor emotional and practical responses and greater non-nose or eye scores. Females, on the other hand, reported better sleep patterns, nasal and eye symptoms. Consequently, the two study results tend to contradict each other, with respect to the gender factor.
Economic burden of rhinitis in the USA
The USA presents well-researched figures which reflect the economic burden of rhinitis in the country. In 1997, the total cost of treating rhinitis was $1.23 billion, with $1.14 billion as direct costs and $17 million as indirect costs. As per the data in the white book on allergy, the total direct expenditure on allergic rhinitis during 2005 was US$11.2 billion, while the indirect costs amounted up to US$ 9.7 billion. The total expenditure on the disease amounted up to $20.9 billion (Pawankar et al. 2011).
Mudarri (2016) presented the economic burden for 2014, using the data for both costs of illness and willingness to pay. These cost estimations are focused on allergies from indoor dampness and molds. The total annual cost for allergic rhinitis was $2.3–$4.7 billion. Also, the cost due to all possible causes was reported to be $24.8 billion, which shows an increase of $13.6 billion.
As a result of the critical review of published literature for both countries, it could be said that they differ a lot in terms of economic assessments of the diseased conditions. The very recent studies from India, present the dearth of awareness among the relevant authorities and academia to document the cost issues for allergies. However, this could also be perceived as an awakening of the researchers towards the issue of allergies. The American stance, on the other hand, presents sufficient data and a gradual increase in cost expenditures was seen. Due to the inconsistency between the data from developed USA and developing India, a direct contrast between the two regions was not possible.
- Cardell, L.O. et al., 2016. TOTALL: high cost of allergic rhinitis—a national Swedish population-based questionnaire study. NPJ primary care respiratory medicine, 26, p.15082.
- Chauhan, G. & Khokar, C.P., 2015. Quality of life in allergic rhinitis patients. International Journal of Indian Psychology, 2(2), p.114. Available at: https://books.google.co.in/books?id=TR_gCwAAQBAJ&pg=PA117&lpg=PA117&dq=cost+of+illness+allergic+rhinitis+India&source=bl&ots=Qg-_0mHGlX&sig=UXuVXLMgfPFhujZpujwuHREj2GI&hl=en&sa=X&ved=0ahUKEwidgIqUpNLYAhUIv5QKHblxDjAQ6AEIYTAJ#v=onepage&q=cost of illness al.
- Hellgren, J. et al., 2010. Allergic rhinitis and the common cold – high cost to society. Allergy, 65(6), pp.776–783.
- Malone, D.C. et al., 1997. A cost of illness study of allergic rhinitis in the United States. Journal of Allergy and Clinical Immunology, 99(1), pp.22–27.
- Mudarri, D.H., 2016. Valuing the economic costs of allergic rhinitis, acute bronchitis, and asthma from exposure to indoor dampness and mold in the US. Journal of environmental and public health, 2016, pp.1–12.
- Pawankar, R. et al. eds., 2011. WAO White Book on Allergy, World Allergy Organization.
- Sharma, N. et al., 2015. To assess the quality of life in patients suffering from allergic rhinitis. Journal of Basic and Applied Sciences, 11, pp.501–506.
- Singh, A. & Kumar, H., 2016. Cost-analysis study of second generation antihistamines used in the treatment of allergic rhinitis in India. International Journal of Basic & Clinical Pharmacology, 5(4), pp.1228–1233.