COST-EFFECTIVENESS AND QUALITY-OF-LIFE OUTCOMES OF MONTELUKAST–LEVOCETIRIZINE VERSUS MONTELUKAST–BILASTINE IN ALLERGIC RHINITIS: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Allergic rhinitis (AR) substantially impairs quality of life and imposes direct and indirect economic burdens, particularly in countries with high out-of-pocket health expenditure. Fixed-dose combinations of montelukast with second-generation antihistamines are widely prescribed, yet comparative data on cost-effectiveness and patient well-being in the Indian setting are limited. Methods: Current prospective observational study was conducted in a tertiary care centre and included 60 patients with AR, with or without coexisting asthma. Group A(n=30) participants received  montelukast 10 mg + levocetirizine 5 mg whereas Group B(n=30) participents recieved montelukast 10 mg + bilastine 20 mg once daily. Quality of life was assessed using the WHO-5 Well-Being Index at baseline and day 28. Direct drug costs were estimated from market prices of ten widely available brands per group. Cost-effectiveness ratio (CER) was calculated as cost per unit reduction in Total Nasal Symptom Score (TNSS). Results: Findings revealed that baseline characteristics were comparable between groups. Both regimens significantly improved WHO-5 well-being scores (mean improvement: 9.43 ± 3.24 in Group A vs 9.24 ± 2.57 in Group B; and reduced TNSS (6.64 ± 1.60 vs 6.54 ± 1.38; p=0.81). The average 28-day cost was lower in Group A (₹403.84 ± 212.90) than Group B (₹457.99 ± 139.56). CER was numerically lower for montelukast–levocetirizine (₹60.82 ± 32.06) compared to montelukast–bilastine (₹70.03 ± 21.34), not statistically significant (p=0.511). Conclusions: Both combinations effectively improved well-being and symptom control. Montelukast–levocetirizine offered a modest economic advantage, whereas montelukast–bilastine provided a non-sedating alternative. These findings support patient-centred, value-conscious prescribing decisions in AR managemt.