Economic Impact and Clinical Outcomes of Omalizumab Add-On Therapy for Patients with Severe Persistent Asthma: A Real-World Study

BACKGROUND

Omalizumab is a fully humanized monoclonal antibody indicated as add-on therapy to improve asthma control in patients with severe persistent allergic asthma.

AIMS

The aim of this study was to evaluate social, healthcare expenditure and clinical outcomes changes after incorporating omalizumab into standard treatment in the control of severe asthma.

METHODS

In this multicentre retrospective study, a total of 220 patients were included from 15 respiratory medicine departments in the regions of Andalusia and Extremadura (Spain). Effectiveness was calculated as a 3-point increase in the Asthma Control Test (ACT) and a reduction in the annual number of exacerbations. The economic evaluation included both direct and indirect costs. Incremental cost-effectiveness ratio (ICER) was calculated. Results from the year before and the year after incorporation of omalizumab were compared.

RESULTS

After adding omalizumab, improvement of lung function, asthma and rhinitis according to patient perception, as well as the number of exacerbations and asthma control measured by the ACT score were observed. Globally, both healthcare resources and pharmacological costs decreased after omalizumab treatment, excluding omalizumab cost. When only direct costs were considered, the ICER was €1712 (95% CI 1487-1995) per avoided exacerbation and €3859 (95% CI 3327-4418) for every 3-point increase in the ACT score. When both direct and indirect costs were considered, the ICER was €1607 (95% CI 1385-1885) for every avoided exacerbation and €3555 (95% CI 3012-4125) for every 3-point increase.

CONCLUSIONS

Omalizumab was shown to be an effective add-on therapy for patients with persistent severe asthma and allowed reducing key drivers of asthma-related costs.

Histological features and survival in NSCLC patients treated with surgery with curative intention

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Background: New classification of adenocarcinomas and better typing of histological characteristics of lung tumors leads us to wonder if these histological data could have a prognostic repercussion in the NSCLC who were into curative intent surgery Methods: We followed 95 patients with stage I-III NSCLC underwent surgery in a 4 year period (2010-2013), until August 2016. Most patients were male (82%), smokers (90%, 44% exsmokers and 56% active , median age at diagnosis was 64 years, 47% had a previous COPD, and 52% were diagnosed of NSCLC without any symptom of lung cancer. 79% patients had lobectomy or sleeve resection, and 21% pneumonectomy. 47% patients had adjuvant chemotherapy (CT) Results: We found no significant differences in age of diagnosis between men (64.95 y) and women (58.65 y) (p = 0.066) nor in survival time. Median disease-free survival (DFS) is 15 months and overall survival (OS) is 49 months. If we analyze DFS from surgery to the first relapse, most happen at first 2 years (80%). By stage, OS at 5 years is 73% in stage IA, 58% stage IB, 46% stage IIA, 36% stage IIB, 24% for stage IIIA and 9% in IIIB. We had 49% adenocarcinomas (most frequent, 53%, acinar subtype), and 51% squamous, and we found no significant difference between histologies, nor between subtypes. But there was a significant difference between DFS, favorable for mild lymphoid response (20 months) with respect to moderate or intense response (11 months) Conclusions: We found that we are underusing adjuvant CT. In our group there is no difference in survival for tumor size, linfovascular invasion, histological grade or histology, but we found a better DFS for mild lymphoid response vs moderate-intense pattern. This finding may be related to the antitumor activity of the immune system, and we want to validate it prospectively, and its relationship with subsequent immune therapy response.