Budget Impact of Intravenous Cetirizine Hydrochloride for the Treatment of Acute Urticaria in the Emergency Department Setting.

BACKGROUND: First-line treatment of acute urticaria with an intravenous (IV) antihistamine in emergency departments had previously been limited to first-generation diphenhydramine, which can cause sedation and anticholinergic effects. IV cetirizine, a second-generation antihistamine, was approved in October 2019 by the US Food and Drug Administration for the treatment of acute urticaria. In a phase 3 clinical trial, IV cetirizine demonstrated comparable efficacy in treating acute urticaria based on reduction in 2-hour patient-reported pruritus scores, with shorter duration of emergency department visits and fewer return visits, compared with IV diphenhydramine. OBJECTIVE: To assess the budget impact of treating patients with acute urticaria with IV cetirizine compared with IV diphenhydramine from an emergency department perspective by modeling clinical, facility, and cost parameters for hospital formulary considerations. METHODS: Using data from the pivotal phase 3 clinical trial, federal health agencies, and peerreviewed literature, our model evaluated a hypothetical emergency department with 50,000 (Case 1) and 100,000 (Case 2) all-cause visits per year with a nationally representative payer mix and age distribution. RESULTS: In Case 1, an estimated 204 visits per year were attributed to acute urticaria. With IV diphenhydramine as the treatment, the estimated annual net revenue to the emergency department was $56,768 (emergency department revenue of $131,056 minus a cost of $74,289). In the scenario with IV cetirizine, the estimated net revenue was $84,644 (emergency department revenue of $196,295 minus a cost of $113,080). Altogether, the adoption of IV cetirizine had a positive net impact on annual budget of $27,876. In Case 2, we found a larger net positive budget impact of $55,752. CONCLUSION: Adoption of IV cetirizine for acute urticaria treatment in the emergency department setting resulted in a positive budget impact. This outcome was driven by the shorter duration of visits, fewer 24-hour return visits, and higher drug revenue associated with IV cetirizine, compared with IV diphenhydramine. [ABSTRACT FROM AUTHOR]