Mapping naso-ocular symptom scores to EQ-5D-5L utility values in Japanese cedar pollinosis

Hiroshi Kumanomidou, Kengo Kanai, Aiko Oka, Takenori Haruna, Yuji Hirata, Sei ichiro Makihara, Takaya Higaki, Maki Akamatsu, Yoshitaka Okamoto, Shunya Ikeda, Mitsuhiro Okano

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: The total naso-ocular symptom score (TSS) is widely used as an endpoint to evaluate the severity of seasonal allergic rhinitis. However, it is not a generic preference-based measure. We sought to develop an algorithm for mapping between the TSS and health utility in Japanese cedar pollinosis (JCP). We also performed a cost-utility analysis of sublingual immunotherapy (SLIT) for JCP by using this algorithm. Methods: Patients with JCP filled out the TSS questionnaire and EQ-5D-5L simultaneously during the pollen season in 2019 and in 2020. We estimated a direct utility mapping model by regressing responses to individual TSS questions directly onto utility. The incremental cost-effectiveness ratio (ICER) of active SLIT to a placebo was determined by examining the drug expense and the estimated quality-adjusted life year (QALY) using a dataset from a double-blind placebo-controlled clinical trial. Results: A total of 238 records were included for analysis. The estimated utility decreased with increasing severity of rhinitis. Patients with comorbid asthma showed lower utility. A negative and significant correlation was seen between the TSS and utility in both 2019 and 2020. The estimated equations were: Y(utility) = −0.0161∗X(TSS) + 1.005 in non-asthmatic JCP patients. The ICER of active SLIT to the placebo was estimated to be 4,049,720 and 6,011,218 JPY/QALY in the first and second year, respectively. Conclusions: It is possible to reasonably predict utility from the total naso-ocular symptom score by using regression models. In the estimated algorithm, pre-seasonal SLIT for JCP is cost-effective.

Original languageEnglish
Pages (from-to)207-213
Number of pages7
JournalAllergology International
Issue number2
Publication statusPublished - Apr 2022


  • Allergic rhinitis
  • EQ-5D-5L
  • Mapping
  • QALY
  • Symptom score

ASJC Scopus subject areas

  • Immunology and Allergy


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