Targeting subgroups to realise value: the cost-effectiveness of omalizumab in severe allergic asthma

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DateUnpublished - 2013
Original languageEnglish

Abstract

Objectives
Omalizumab is an effective add-on therapy to improve control of severe allergic asthma, but it is unlikely to be cost-effective to the overall licensed population, i.e. those uncontrolled at high-doses of inhaled corticosteroids. However, there may be patients with more severe asthma to whom omalizumab represents good value for money. This study aims to evaluate the cost-effectiveness of omalizumab in patients with previous hospitalisation for asthma, on maintenance use of oral corticosteroids (OCS) and ≥ 3 exacerbations in the previous year.

Methods
A model was developed to evaluate the long-term cost-effectiveness of omalizumab. Costs were from a health service perspective and outcomes were measured as quality-adjusted life years (QALYs). Patient subgroups were defined post hoc based on data collected in clinical trials. The impact of alternative assumptions and parameter inputs was explored with scenario, one-way and probabilistic sensitivity analyses.

Results
The incremental cost-effectiveness ratio (ICER) across the three patient subgroups was smaller than in the overall population but still well above conventional thresholds used in the UK at £46,431 for the prior hospitalisation subgroup, £50,181 for the maintenance OCS subgroup and £41,429 for the ≥ 3 exacerbations subgroup. Considerable reductions on the ICER are achieved assuming higher asthma-related mortality and more severe health burden from OCS use.


Conclusions
Although omalizumab has been shown to improve health outcomes, its cost-effectiveness relies on the plausibility of assumptions regarding the health losses from long-term use of OCS and asthma-related mortality. However, both are empirical questions which can be answered with further research. Such research would be valuable not only for decision making in severe asthma but also for other conditions treated with maintenance OCS.

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