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List of abbreviations

All abbreviations that have been used in this report are listed here unless the abbreviation is well known (e.g. NHS), or it has been used only once, or it is a non-standard abbreviation used only in figures/tables/appendices, in which case the abbreviation is defined in the figure legend or in the notes at the end of the table.

Definition of the 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.


Pharmalgen® products (ALK Abelló) are used for the diagnosis and treatment of immunoglobulin E (IgE)-mediated allergy to bee and wasp venom. The aim of this systematic review was to assess whether use of Pharmalgen products is of clinical value when providing VIT to individuals with a history of severe reaction to bee and wasp venom, and whether it would be considered cost-effective compared with alternative treatment options available in the NHS in England and Wales.

Executive summary

Each year in the UK there are between two and nine deaths from anaphylaxis caused by bee and wasp venom. Anaphylactic reactions to bee and wasp venom are a medical emergency, necessitating immediate treatment with drugs, oxygen and fluids to decrease the patient's response to the venom and support breathing and circulation.

Assessment of cost-effectiveness

A systematic review of the economic literature was conducted to identify the existing evidence assessing the cost-effectiveness of PhVIT for the treatment of bee and wasp venom allergy. The search strategy shown in Chapter 3 was used to identify the relevant studies for inclusion in the review. Three studies were identified; two were full papers, and one was in abstract format. None of the studies compared PhVIT with AAIs, HDAs or avoidance advice, the studies were USA based and costs were expressed in US dollars. The AG was unable to apply any systematic review evaluation checklist to the identified studies and therefore brief summaries of each study are reported below.

Assessment of clinical effectiveness

The methods used for reviewing both the clinical effectiveness and the cost-effectiveness literature are described in this section.

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