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Domínguez-Ortega J, Laorden D, Vílchez-Sánchez F, Bañas-Conejero D, Quirce S. Cost-effectiveness and resource use analysis of patients with asthma before and after treatment with mepolizumab in a real-life setting. J Asthma 2024; 61:39-47. [PMID: 37503953 DOI: 10.1080/02770903.2023.2241905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To define the cost-effectiveness and health resource use of mepolizumab in a cohort of patients with severe eosinophilic asthma in real-life conditions in Spain. METHODS This was an observational, retrospective, single-center study. Patients included were diagnosed with severe eosinophilic asthma and treated with mepolizumab 100 mg subcutaneous (SC) 4-weekly for 12 months. Outcomes evaluated: incremental cost-effectiveness ratio (ICER), number of exacerbations, disease control with the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), and direct and indirect cost per patient. RESULTS 12 months after mepolizumab initiation, a significant decrease in exacerbations was shown, from a mean (standard deviation [SD]) of 3.1 (2.6) to 0.7 (1.5), an increase from 4.9 (0.4) to 6.1 (0.5) in AQLQ, and from 14.9 (5.7) to 21.5 (3.9) in ACT scores. The number of cortico-dependent patients significantly decreased from 53.3% to 13.3% during this period. There was a significant decrease of 94% in the cost of hospitalization, from a mean (SD) of €4063.9 (5423.9) pretreatment to €238.6 (1306.9) post-treatment (p = 0.0003). Total costs decreased significantly from a median of €2,423.1 (1,512.8; 9,320.9) pretreatment to €1,177.5 (965.0; 1,737.8) post-treatment if mepolizumab was excluded. ICER per exacerbation avoided was €3606.9, per 3-point ACT score increase €3934.8, and per 0.5-point AQLQ score increase €3606.9. CONCLUSIONS Mepolizumab improves control of asthma and quality of life in patients with severe diseases in a cost-effectiveness range. The number of exacerbations decreased, and there was a clear reduction in primary care visits and hospitalizations. Further economic analyses of biological therapies for asthma are required.
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Affiliation(s)
- Javier Domínguez-Ortega
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Daniel Laorden
- Department of Pulmonology, Hospital Universitario La Paz, Madrid, Spain
| | - Francisca Vílchez-Sánchez
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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Alves S, Rufo JC, Crispim J. Economic evaluation of biological treatments in patients with severe asthma: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:733-747. [PMID: 37265078 DOI: 10.1080/14737167.2023.2221435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Asthma is a highly prevalent disease, one of the chronic diseases with the highest economic costs; thus, it imposes a high economic burden on society, the healthcare system, patients, and third-party payers. Contrary to this study, until now, systematic reviews of economic evaluations (EEs) of treatments for severe asthma have not been exclusively focused on biological treatments, and have included a small number of studies and only model-based EEs. METHODS This study systematically reviews EEs of biological therapies for severe asthma published until December 2022 using PRISMA guidelines. The review analyzes the cost-effectiveness of biologicals in comparison to SOC, or SOC plus OCS. The quality of the EEs is assessed using Consensus on Health Economics Checklist extended (CHEC-extended). RESULTS Thirty-nine studies were eligible: 15 based on a Markov model, and 19 trial-based; eight adopting societal and NHS perspectives, and seven the payer's perspective. The reviewed EEs addressed cost-effectiveness, cost-utility, and incremental costs and outcomes comparison. Their findings were mainly expressed through ICER-incremental cost-effectiveness ratio (24 studies: 13 concluded that biological were cost-effective) and cost comparison analysis (14 studies: 6 concluded that biological were cost-effective), and were sensitive to a wide variety of factors (e.g. medication cost, treatment response, time horizon, utility benefits, mortality, exacerbation rate, discount rate, etc.). CONCLUSIONS There has been some ambiguity concerning the EE of biological therapies due to variation in choice of study design and contradictory results. Nevertheless, it can be concluded that biological treatments improve health outcomes, in many contexts at a high cost.
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Affiliation(s)
- Sara Alves
- Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Unidade de Epidemiologia, Instituto de Saúde Pública, Porto, Portugal
- Serviço E Laboratório de Imunologia Básica E Clínica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - José Crispim
- NIPE, Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
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Veettil SK, Vincent V, Shufelt T, Behan E, Syeed MS, Thakkinstian A, Young DC, Chaiyakunapruk N. Incremental net monetary benefit of biologic therapies in moderate to severe asthma: a systematic review and meta-analysis of economic evaluation studies. J Asthma 2023:1-13. [PMID: 36825403 DOI: 10.1080/02770903.2023.2183407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma. METHODS We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6-11 years). Heterogeneity was assessed using the I2 statistic. RESULTS A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP (n = 8, INB, -6,341 (95% CI, -$25,000 to $12,210), I2=86.18%) and SP (n = 5, -$14,000 (-$170,000 to $140,000), I2=75.64%). A similar finding was observed in those aged 6-11 years from the HCPP in LMICs (n = 2, -$45,000 (-$73,000 to $17,000), I2=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity. CONCLUSION The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,School of Medicine, Taylor's University, Selangor, Malaysia
| | - Vanessa Vincent
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Taylor Shufelt
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Emma Behan
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - M Sakil Syeed
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi, Hospital, Mahidol University, Bangkok, Thailand.,Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
| | - David C Young
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Jefferson Antonio B, Patiño DG, Lopez Moreno M. Cost-utility analysis and budget impact of benralizumab as add-on therapy to standard care for severe eosinophilic asthma in Colombia. Expert Rev Pharmacoecon Outcomes Res 2021; 22:299-305. [PMID: 34143703 DOI: 10.1080/14737167.2021.1945445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction:Benralizumab, amonoclonal antibody for human interleukin-5, has been associated with adecrease in asthma exacerbations. The introduction of this drug raises concerns about the economic impact in scenarios with constraints. This study aimed to estimate the cost-utility of benralizumab plus standard care (SoC) vs. SoC alone in adults with severe uncontrolled asthma with evidence of eosinophilic phenotype.Methods:We constructed aMarkov model with three health states (asthma on benralizumab and SOC, asthma on SOC alone, and death) from ahealthcare system perspective over alifetime horizon. The model was populated using local costs while utilities were derived from international literature. Cost and transition probabilities were obtained from amixture of Colombian-specific and internationally published data.Results:The incremental cost-effectiveness ratio (ICER) per patient peryear was $US 42,746per QALY gained. Benralizumab treatment would be cost-effective at the recommended societal US 18,000 WTP threshold if the cost of benralizumab is reduced by 41% more than the base case value.Conclusion:Benralizumab is not cost-effective using WTP of US$18,000per QALY threshold in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
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Affiliation(s)
- Buendía Jefferson Antonio
- Department of Surgery, Research Group in Pharmacology and Toxicology "INFARTO". Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
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Padilla-Galo A, García-Ruiz AJ, Levy Abitbol RC, Olveira C, Rivas-Ruiz F, García-Agua Soler N, Pérez Morales M, Valencia Azcona B, Tortajada-Goitia B, Moya-Carmona I, Levy-Naon A. Real-life cost-effectiveness of benralizumab in patients with severe asthma. Respir Res 2021; 22:163. [PMID: 34044819 PMCID: PMC8155800 DOI: 10.1186/s12931-021-01758-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Availability of clinically effective and cost-effective treatments for severe asthma would be beneficial to patients and national healthcare systems. The aim of this study was to evaluate clinical outcomes and healthcare expenditure after incorporating benralizumab into the standard treatment of refractory eosinophilic asthma. METHODS This was a cross-sectional multicentre study of consecutive patients with refractory eosinophilic asthma who received treatment with benralizumab during at least 12 months. Patient follow-up was performed in specialised severe asthma units. The main effectiveness parameters measured were: the avoidance of one asthma exacerbation, a 3-point increase in the asthma control test (ACT) score, and the difference in utility scores (health-related quality of life) between a 1-year baseline treatment and 1-year benralizumab treatment. The health economic evaluation included direct costs and incremental cost-effectiveness ratios (ICERs). RESULTS After 1 year of treatment with benralizumab, patients with refractory eosinophilic asthma showed an improvement in all the effectiveness parameters analysed: improvement of asthma control and lung function, and decrease in the number of exacerbations, oral corticosteroid (both as corticosteroid courses and maintenance therapy), and inhaled corticosteroid use. The total annual cost per patient for the baseline and benralizumab treatment periods were €11,544 and €14,043, respectively, reflecting an increase in costs due to the price of the biological agent but a decrease in costs for the remaining parameters. The ICER was €602 per avoided exacerbation and €983.86 for every 3-point increase in the ACT score. CONCLUSIONS All the pharmacoeconomic parameters analysed show that treatment with benralizumab is a cost-effective option as an add-on therapy in patients with refractory eosinophilic asthma.
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Affiliation(s)
- A. Padilla-Galo
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - A. J. García-Ruiz
- Chair of Health Economics and Rational Use of Medicines, Department of Pharmacology and Clinical Therapeutics, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | | - C. Olveira
- Pneumology Department, IBIMA (Institute for Biomedical Research of Málaga), Regional University Hospital of Málaga, Avenida Carlos Haya, 29010 Málaga, Spain
- University of Málaga, Málaga, Spain
| | - F. Rivas-Ruiz
- Research Unit, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Spanish Healthcare Network for Chronic Diseases), Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - N. García-Agua Soler
- Chair of Health Economics and Rational Use of Medicines, Department of Pharmacology and Clinical Therapeutics, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - M. Pérez Morales
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - B. Valencia Azcona
- Pneumology Unit, 4th Floor, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - B. Tortajada-Goitia
- Pharmacy and Nutrition Service, Agencia Sanitaria Costa del Sol, Carretera Nacional 340, Km 187, 29603 Marbella, Málaga, Spain
| | - I. Moya-Carmona
- Pharmacy and Nutrition Service, Hospital Universitario Virgen de La Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
| | - A. Levy-Naon
- Pneumology Department, Hospital Universitario Virgen de La Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
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Menzella F, Galeone C, Ghidoni G, Ruggiero P, D'Amato M, Fontana M, Facciolongo N. The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review. Multidiscip Respir Med 2021; 16:787. [PMID: 34557301 PMCID: PMC8404525 DOI: 10.4081/mrm.2021.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.
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Affiliation(s)
- Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Carla Galeone
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Giulia Ghidoni
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Patrizia Ruggiero
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Maria D'Amato
- Department of Pneumology, AO "Dei Colli", University of Naples Federico II, Naples, Italy
| | - Matteo Fontana
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
| | - Nicola Facciolongo
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia IRCCS, Reggio Emilia
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