Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

Cost effectiveness of asthma treatment with a breath-actuated inhaler: how has the story changed?

Abstract

Objectives: A database analysis evaluating the comparative costs and outcomes of asthma treatment with breath-actuated inhalers (BAIs) and metered-dose inhalers (MDIs) has previously been undertaken in 2001. This analysis found that, despite the higher acquisition cost associated with BAIs, economies elsewhere meant that the overall cost associated with BAIs was lower than MDIs. Between 2001 and 2007, the comparative price of MDIs was significantly reduced thus widening the gap between the comparative acquisition cost of MDIs and BAIs. Furthermore, the introduction of specific targets for asthma review included a requirement for regular checks on inhaler technique. Such initiatives may be expected to enhance the overall effectiveness of MDIs. Given the potential impact of such changes, it appeared to be timely to update the original database analysis to assess the extent to which the original findings have been altered by changes in the clinical and economic environment over the past 5 years.

Methods: As in all chronic diseases, it is important that economic analyses evaluate cost effectiveness over as long a period as possible, and so the 2006 analysis was conducted over a 12- and a 24-month time period.

Results: The results emphasised that the clinical benefits associated with BAIs for certain patients can still be translated into greater cost effectiveness, but that altered cost structures required a longer time period for the greater cost effectiveness of BAIs to become evident.

Conclusion: Since completing this study, the reimbursement costs for beclometasone MDIs have increased significantly (since October 2007) due to the discontinuation of Becotide and Becloforte. As a consequence of this higher acquisition cost for MDI inhalers, the current cost-effectiveness advantages of BAI compared to MDI can be expected to be even greater than that identified in the study.     

Seretide: a pharmacoeconomic analysis

Abstract

Background: The costs of asthma and chronic obstructive pulmonary disease (COPD), the two most common chronic respiratory illnesses, are substantial and rising. The fixed-dose combination of fluticasone and salmeterol has been a safe and effective therapy for these diseases.

Objectives: To review the pharmacoeconomic impact of the fixed-dose combination of inhaled fluticasone and salmeterol in asthma and COPD.

Methods: A systematic review of the literature was carried out to identify pharmacoeconomic studies with fixed-dose salmeterol and fluticasone (Seretide, Advair, Viani). In addition, abstracts from recent respiratory meetings were sought, and any unpublished data were requested from the manufacturer.

Results: For asthma, when compared to treatment with inhaled corticosteroid monotherapy and antileukotrienes, alone or combined, salmeterol/fluticasone inhalation produced a higher proportion of successfully treated weeks, improvement in lung function and quality of life, and fewer treatment failures. The costs per quality-adjusted life year (QALY) for fluticasone/salmeterol have been favourable not only in patients with moderate to severe disease but also in patients with mild disease or patients not previously treated with a maintenance therapy. The excess cost per QALY varied from US$2,670 to US$26,445. For COPD, a clear reduction in exacerbation rates and improvement in quality of life has been demonstrated with salmeterol/fluticasone along with a likely improvement in survival rates. The incremental cost per QALY ratio for fluticasone/salmeterol against placebo ranged from US$9,512 to US$64,038.

Conclusions: The data currently available suggest that the cost effectiveness of combination therapy with fluticasone and salmeterol is favourable for asthma and COPD in a variety of clinical settings.     

Symbicort: a pharmacoeconomic review

Abstract

Objective: This systematic review examines the published evidence on the pharmacoecomonics of Symbicort®. Symbicort is a combination inhaler used in asthma and chronic obstructive pulmonary disease (COPD) that contains budesonide and formoterol. In asthma, Symbicort can be used as fixed or adjustable dose maintenance therapy as well as for both maintenance and reliever therapy (SMART).

Method: A literature search of PubMed was carried out to find all publications on the pharmacoeconomics of Symbicort. Additional studies were searched for in the reference lists of the papers retrieved and by searching tables of contents of relevant journals. A total of 13 studies on Symbicort in asthma and 2 studies on Symbicort in COPD were found.

Results: Total costs were lower with Symbicort than with separate inhalers containing budesonide and formoterol. Adjustable dosing maintained control of asthma using less medication and was associated with lower treatment costs than fixed dosing with Symbicort or the combination of fluticasone/salmeterol. SMART improves asthma control, reduces exacerbations and reduces direct and indirect costs compared to fixed maintenance therapy with either Symbicort or fluticasone/salmeterol. In COPD, Symbicort offers clinical advantages over therapy with the monocomponents and these are achieved at little or no extra cost.     

抗氧化剂对支气管哮喘的治疗作用

本文依据支气管哮喘发病与氧自由基有明显关系这一原理,我们将抗氧化剂——维生素正加维生素C试用于临床。结果显示观察组治疗效果明显优于对照组(P<0.05)。提示抗氧化剂有可能成为治疗支气管哮喘的有效药物之一。     

小剂量糖皮质激素联合茶碱缓释片治疗老年哮喘患者的临床疗效

目的：探讨小剂量糖皮质激素联合茶碱缓释片治疗老年哮喘患者的临床疗效。方法将80例老年哮喘患者按按随机数字表法分为两组,对照组患者给予布地奈德气雾剂,观察组患者在其基础上给予茶碱缓释片。比较两组患者的临床疗效。结果观察组患者治疗后FEV1值明显高于对照组,且总有效率明显高于对照组,差异均有统计学意义（均P＜0.05）。结论采用小剂量糖皮质激素联合茶碱缓释片治疗老年哮喘患者,安全有效。     

The value of health interventions: evaluating asthma case management using matching

Despite large public investments in asthma interventions, there are few rigorous assessments of these programmes and little understanding of what comprises an effective intervention. There is a lack of appropriate data, little technical support is provided, and the programs themselves have little incentive to conduct these analyses. In this study, we apply optimal full matching using propensity scores to estimate the impact of an asthma intervention programme across a range of health outcomes. Our participation model is derived using the Deletion, Substitution and Addition (DSA) algorithm, a method used in epidemiology for model selection. We find that the asthma programme in question has no significant effect on participants that distinguishes them from matched nonparticipants, but it is not clear whether this is due to the effectiveness of the programme, heterogeneity of effects or barriers outside the programme's control. Our findings do show how current programmes could be modified to increase their effectiveness and better inform future research.     

Psychometric evaluation of Global Evaluation of Treatment Effectiveness: a tool to assess patients with moderate-to-severe allergic asthma

Summary

Recent trials of treatment for patients with moderate to severe allergic (immunoglobulin E-mediated) asthma have included a Global Evaluation of Treatment Effectiveness (GETE), which is completed by both the patient and the physician. The current analyses were designed to explore some psychometric properties of this measure using secondary analysis of trial data.

The results found some evidence to support the psychometric properties of the measure, and some evidence that was more equivocal. The GETE had low to moderate rates of missing data. There was also a high level of agreement between the two measures. The five levels of the GETE were significantly differentiated in terms of symptom scores, use of rescue medication and forced expiratory volume (physician version only), and health-related quality of life (Asthma Quality of Life Questionnaire).

The GETE is a simple measure of perceived treatment effectiveness that reflects clinical outcomes and health-related quality of life, and is not burdensome for patients or physicians.