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Cost-Effectiveness of Biological Asthma Treatments: A Systematic Review and Recommendations for Future Economic Evaluations

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Abstract

Background

Recently developed asthma biological therapies have been shown to provide relief for severe asthma patients not controlled by inhaled treatment. Given the relatively high costs of biological therapies, cost-effectiveness analyses (CEAs) may be required as a prerequisite for coverage and reimbursement.

Objective

We aimed to systematically review published literature on the economic impact of biological asthma therapies and to identify key drivers that impact cost-effectiveness in order to provide recommendations for future economic evaluations.

Methods

We conducted a systematic literature search in PubMed and Google Scholar. We included studies that assessed the cost-effectiveness of asthma biologics and were published in English between 2000 and 2018. The Quality of Health Economic Studies (QHES) instrument was used to evaluate quality.

Results

Twenty asthma biological CEAs were identified. Nineteen studies analyzed the cost-effectiveness of omalizumab, and one study analyzed mepolizumab. Ten studies concluded that omalizumab was cost-effective in base-case scenarios, four studies concluded omalizumab was not cost-effective, and the remaining studies concluded omalizumab or mepolizumab was cost-effective only when targeted to specific severe subgroups or given considerable price discounts. Key drivers of cost-effectiveness included day-to-day health-related quality of life (HRQoL), asthma-related mortality, acquisition price of the biological therapy, and time horizon.

Conclusions

Most studies recommended carefully targeting biological therapy to specific populations such as responders or discounting acquisition price in order to further improve value. The quality of the studies was generally satisfactory, but improved evidence is needed linking HRQoL to utilities as well as understanding interventions’ impact on asthma-related mortality. Key recommendations from this review may allow for greater comparability across future cost-effectiveness studies.

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Authors and Affiliations

  1. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA

    R. Brett McQueen, Danielle N. Sheehan, Melanie D. Whittington & Jonathan D. Campbell

  2. Department of General Practice and Elderly Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Job F. M. van Boven

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  1. R. Brett McQueen
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  4. Job F. M. van Boven
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Contributions

Two investigators (R.B.M. and D.N.S.) performed the initial search and reviewed each article for quality using the QHES tool. If the quantitative score differed between reviewers, co-authors (J.v.B., M.D.W., and J.D.C.) discussed the score in order to reach a consensus. R.B.M. and D.N.S. prepared the first draft of the manuscript. J.v.B., M.D.W., and J.D.C. provided written text in the manuscript and edited all versions of the manuscript.

Corresponding author

Correspondence to R. Brett McQueen.

Ethics declarations

R. B. M. has received consultancy fees from the Respiratory Effectiveness Group and research support from the Institute for Clinical and Economic Review. M. D. W. has received research support from the Institute for Clinical and Economic Review. J. D. C. has received research support from the Institute for Clinical and Economic Review, has served as an asthma advisor to Regeneron and Sanofi Aventis, and has received travel support from the Respiratory Effectiveness Group. J. v.B. and/or his Institution has received consultancy fees from AstraZeneca, speaker fees from Menarini, research grants from AstraZeneca, GSK, Boehringer Ingelheim, and Chiesi, and travel support from the Respiratory Effectiveness Group and the European COPD Coalition.

Data availability statement

Please see the supplementary appendix for all final QHES scores by study (see the electronic supplementary material).

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McQueen, R.B., Sheehan, D.N., Whittington, M.D. et al. Cost-Effectiveness of Biological Asthma Treatments: A Systematic Review and Recommendations for Future Economic Evaluations. PharmacoEconomics 36, 957–971 (2018). https://doi.org/10.1007/s40273-018-0658-x

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