Cost-Effectiveness Analysis of Omalizumab for Severe Allergic Asthma in Japan Using Real-World Evidence

OBJECTIVES

Omalizumab is a recommended add-on therapy for patients with severe allergic asthma who remain uncontrolled despite treatment with standard of care (SoC). This study evaluated the cost-effectiveness of omalizumab compared with SoC applying real-world clinical outcomes in adult patients with severe allergic asthma in Japan.

METHODS

A validated Markov model was adapted for Japan and compared the cost-effectiveness of omalizumab as an add-on therapy to SoC versus SoC alone using the most recently updated price of omalizumab. A Japanese real-world postmarketing surveillance and a pivotal randomized clinical trial were used as inputs for clinical effectiveness. Japanese life tables and literature were accessed for mortality data and unit costs were extracted from a Japanese insurance claims database. Quality of life data were retrieved from the clinical trial.

RESULTS

In the base case, the incremental cost-effectiveness ratio for omalizumab add-on therapy was ¥2.85 million per quality-adjusted life-year gained (approximately €21 000; 1€ = ¥133.26) compared with SoC alone. The model appeared to be most sensitive to changes in clinically significant severe exacerbation fatality, day-to-day asthma symptom utilities for SoC, discount rates for benefits, day-to-day asthma symptom utilities for omalizumab responders, time horizon, and the annual cost of omalizumab. The results of the probabilistic sensitivity analysis showed that the probability of omalizumab being cost-effective was 93% to 98% at a threshold of ¥5 to ¥6 million (willingness-to-pay for 1 quality-adjusted life-year).

CONCLUSIONS

Omalizumab add-on therapy is cost-effective compared with SoC alone in Japan in severe allergic asthma population who are uncontrolled with high-dose inhaled corticosteroid and other controllers.

Management of hypophosphatemia induced by high-flux hemodiafiltration for the treatment of vancomycin toxicity: intravenous phosphorus therapy versus use of a phosphorus-enriched dialysate

Intensive high-flux hemodiafiltration is often used in the management of vancomycin toxicity. We describe two patients who developed hypophosphatemia as a consequence of this form of therapy. The first patient was treated with an intravenous phosphorus infusion. For the second patient, hypophosphatemia was corrected, during hemodiafiltration, with the use of a phosphorus-enriched dialysate. The latter dialysate was prepared by adding sodium phosphate salts to the "base concentrate" of a dual-concentrate, bicarbonate-based dialysate delivery system. This simple method was more efficient than intravenous therapy in ameliorating the hypophosphatemia secondary to aggressive hemodiafiltration treatment.

Removal of Foscarnet by Hemodialysis using Dialysate-Side Values

Foscarnet is an antiviral agent widely used in the treatment of cytomegalovirus (CMV) infection. We describe a cardiac transplant patient, who while being maintained with hemodialysis because of tobramycin-induced acute renal failure, was given Foscarnet for disseminated CMV infection. Using dialysate-side clearance methodology, we found the dialyzer clearance of Foscarnet to be in the order of 89 ml/min. (Int J Artif Organs 2000; 23: 165–7)

Removal of Foscarnet by hemodialysis using dialysate-side values

Foscarnet is an antiviral agent widely used in the treatment of cytomegalovirus (CMV) infection. We describe a cardiac transplant patient, who while being maintained with hemodialysis because of tobramycin-induced acute renal failure, was given Foscarnet for disseminated CMV infection. Using dialysate-side clearance methodology, we found the dialyzer clearance of Foscarnet to be in the order of 89 ml/min.

Efficacy of cyproheptadine for nightmares associated with posttraumatic stress disorder

A retrospective review of the psychiatric records of nine patients with posttraumatic stress disorder (PTSD) was conducted to determine the efficacy of cyproheptadine in relieving nightmares. The treatment dose was 4 to 12 mg at bedtime. The response varied from complete remission to a decrease in the intensity and frequency of nightmares.

Risperidone-induced galactorrhea associated with a prolactin elevation

We report on the occurrence of galactorrhea associated with a prolactin elevation within weeks of treatment with risperidone. One of our patients was switched to a typical antipsychotic, with an improvement in the galactorrhea. The other patient was continued on risperidone due to a robust response, while her galactorrhea was partially treated with bromocriptine. The mechanism of prolactin elevation with risperidone is unclear. These cases suggest the need for further studies.

Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder

OBJECTIVE

To increase understanding of the needs of elderly patients with serious mental illness, the study analyzed and compared use of hospital-based services by geriatric patients with bipolar disorder and schizophrenia.

METHODS

The sample consisted of 23 patients with bipolar disorder and 49 patients with schizophrenia age 65 or older admitted to the Cleveland Veterans Affairs Medical Center over a two-year period. Patients' charts were reviewed to assess psychiatric and medical hospitalizations over the past ten years. Comorbid medical diagnoses, prescription patterns, and competency status were also reviewed.

RESULTS

Patients in both diagnostic groups used inpatient services relatively frequently, with a mean of four hospitalizations in ten years. Length of stay among patients with schizophrenia (mean = 58.2 days) was almost twice as long as that of patients with bipolar disorder. Hospitalization for medical reasons was infrequent. Mood-stabilizing medications, usually lithium, were prescribed to most patients with bipolar disorder, and antipsychotics were prescribed to most patients with schizophrenia and less than half of the patients with bipolar disorder. More than half of the patients with schizophrenia had legal guardians, but few patients with bipolar disorder did so.

CONCLUSIONS

Findings of this and other studies suggest that although the prognosis for persons with serious mental illnesses may have improved over the last several decades, these illnesses do not "burn out" in older adults. Elderly patients continue to make frequent use of inpatient psychiatric hospitalization and pharmacological interventions.

Psychosis in Apert's syndrome with partial agenesis of the corpus callosum

A 19-year-old male with Apert's syndrome developed psychotic symptoms that responded to haloperidol. He was also found to have partial agenesis of the corpus callosum and enlarged lateral ventricles on a head CT scan. The implications of these findings in the context of psychotic symptoms are discussed. There are no previous reports of psychosis in patients with Apert's syndrome.