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Hockenhull J, Elremeli M, Cherry MG, et al. A Systematic Review of the Clinical Effectiveness and Cost-Effectiveness of Pharmalgen® for the Treatment of Bee and Wasp Venom Allergy. Southampton (UK): NIHR Journals Library; 2012 Mar. (Health Technology Assessment, No. 16.12.)

2Definition of the decision problem

Decision problem

The remit of this review is to assess the clinical effectiveness and cost-effectiveness of PhVIT in providing immunotherapy to individuals with a history of type 1 IgE-mediated systemic allergic reaction to bee and wasp venom. Table 3 shows the key elements of the decision problem of the appraisal.

TABLE 3. Key elements of the decision problem.

TABLE 3

Key elements of the decision problem.

Following completion of the review protocol and preliminary searches, revisions were made to the review protocol so as to include any VIT as a comparator to PhVIT, and comparative studies in addition to RCTs, systematic reviews and economic evaluations. These are reflected in the revised decision problem set out in Table 3.

This review, for the National Institute for Health and Clinical Excellence (NICE), was limited to Pharmalgen, which is the only licensed venom product for use in VIT in the UK. At the time of writing, a systematic review of all VIT was being undertaken by the Cochrane Skin Group, to be published in 2011.33 To place the current review in the context of the overall literature on the clinical effectiveness of VIT, the Assessment Group (AG) worked in collaboration with the Cochrane Skin Group to provide the best available summary of the evidence for the use of VIT in the treatment of Hymenoptera allergy.

Overall aims and objectives of assessment

The aim of this review was to assess the clinical effectiveness and cost-effectiveness of Pharmalgen in providing immunotherapy to individuals with a history of type 1 IgE-mediated systemic allergic reaction to bee and wasp venom. The review considered the effectiveness of PhVIT when compared with alternative treatment options available in the NHS, including advice on the avoidance of bee and wasp stings, and HDA and AAI prescription and training. The review also examined the existing health economic evidence and identified the key economic issues related to the use of PhVIT in UK clinical practice and developed a de novo economic model.

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Cover of A Systematic Review of the Clinical Effectiveness and Cost-Effectiveness of Pharmalgen® for the Treatment of Bee and Wasp Venom Allergy
A Systematic Review of the Clinical Effectiveness and Cost-Effectiveness of Pharmalgen® for the Treatment of Bee and Wasp Venom Allergy.
Health Technology Assessment, No. 16.12.
Hockenhull J, Elremeli M, Cherry MG, et al.
Southampton (UK): NIHR Journals Library; 2012 Mar.

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