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Domínguez-Ortega J, Laorden D, Vílchez-Sánchez F, Bañas-Conejero D, Quirce S. Cost-effectiveness and resource use analysis of patients with asthma before and after treatment with mepolizumab in a real-life setting. J Asthma 2024; 61:39-47. [PMID: 37503953 DOI: 10.1080/02770903.2023.2241905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To define the cost-effectiveness and health resource use of mepolizumab in a cohort of patients with severe eosinophilic asthma in real-life conditions in Spain. METHODS This was an observational, retrospective, single-center study. Patients included were diagnosed with severe eosinophilic asthma and treated with mepolizumab 100 mg subcutaneous (SC) 4-weekly for 12 months. Outcomes evaluated: incremental cost-effectiveness ratio (ICER), number of exacerbations, disease control with the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), and direct and indirect cost per patient. RESULTS 12 months after mepolizumab initiation, a significant decrease in exacerbations was shown, from a mean (standard deviation [SD]) of 3.1 (2.6) to 0.7 (1.5), an increase from 4.9 (0.4) to 6.1 (0.5) in AQLQ, and from 14.9 (5.7) to 21.5 (3.9) in ACT scores. The number of cortico-dependent patients significantly decreased from 53.3% to 13.3% during this period. There was a significant decrease of 94% in the cost of hospitalization, from a mean (SD) of €4063.9 (5423.9) pretreatment to €238.6 (1306.9) post-treatment (p = 0.0003). Total costs decreased significantly from a median of €2,423.1 (1,512.8; 9,320.9) pretreatment to €1,177.5 (965.0; 1,737.8) post-treatment if mepolizumab was excluded. ICER per exacerbation avoided was €3606.9, per 3-point ACT score increase €3934.8, and per 0.5-point AQLQ score increase €3606.9. CONCLUSIONS Mepolizumab improves control of asthma and quality of life in patients with severe diseases in a cost-effectiveness range. The number of exacerbations decreased, and there was a clear reduction in primary care visits and hospitalizations. Further economic analyses of biological therapies for asthma are required.
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Affiliation(s)
- Javier Domínguez-Ortega
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Daniel Laorden
- Department of Pulmonology, Hospital Universitario La Paz, Madrid, Spain
| | - Francisca Vílchez-Sánchez
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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Alves S, Rufo JC, Crispim J. Economic evaluation of biological treatments in patients with severe asthma: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:733-747. [PMID: 37265078 DOI: 10.1080/14737167.2023.2221435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Asthma is a highly prevalent disease, one of the chronic diseases with the highest economic costs; thus, it imposes a high economic burden on society, the healthcare system, patients, and third-party payers. Contrary to this study, until now, systematic reviews of economic evaluations (EEs) of treatments for severe asthma have not been exclusively focused on biological treatments, and have included a small number of studies and only model-based EEs. METHODS This study systematically reviews EEs of biological therapies for severe asthma published until December 2022 using PRISMA guidelines. The review analyzes the cost-effectiveness of biologicals in comparison to SOC, or SOC plus OCS. The quality of the EEs is assessed using Consensus on Health Economics Checklist extended (CHEC-extended). RESULTS Thirty-nine studies were eligible: 15 based on a Markov model, and 19 trial-based; eight adopting societal and NHS perspectives, and seven the payer's perspective. The reviewed EEs addressed cost-effectiveness, cost-utility, and incremental costs and outcomes comparison. Their findings were mainly expressed through ICER-incremental cost-effectiveness ratio (24 studies: 13 concluded that biological were cost-effective) and cost comparison analysis (14 studies: 6 concluded that biological were cost-effective), and were sensitive to a wide variety of factors (e.g. medication cost, treatment response, time horizon, utility benefits, mortality, exacerbation rate, discount rate, etc.). CONCLUSIONS There has been some ambiguity concerning the EE of biological therapies due to variation in choice of study design and contradictory results. Nevertheless, it can be concluded that biological treatments improve health outcomes, in many contexts at a high cost.
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Affiliation(s)
- Sara Alves
- Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Unidade de Epidemiologia, Instituto de Saúde Pública, Porto, Portugal
- Serviço E Laboratório de Imunologia Básica E Clínica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - José Crispim
- NIPE, Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
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Veettil SK, Vincent V, Shufelt T, Behan E, Syeed MS, Thakkinstian A, Young DC, Chaiyakunapruk N. Incremental net monetary benefit of biologic therapies in moderate to severe asthma: a systematic review and meta-analysis of economic evaluation studies. J Asthma 2023:1-13. [PMID: 36825403 DOI: 10.1080/02770903.2023.2183407] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma. METHODS We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6-11 years). Heterogeneity was assessed using the I2 statistic. RESULTS A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP (n = 8, INB, -6,341 (95% CI, -$25,000 to $12,210), I2=86.18%) and SP (n = 5, -$14,000 (-$170,000 to $140,000), I2=75.64%). A similar finding was observed in those aged 6-11 years from the HCPP in LMICs (n = 2, -$45,000 (-$73,000 to $17,000), I2=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity. CONCLUSION The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,School of Medicine, Taylor's University, Selangor, Malaysia
| | - Vanessa Vincent
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Taylor Shufelt
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Emma Behan
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - M Sakil Syeed
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi, Hospital, Mahidol University, Bangkok, Thailand.,Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
| | - David C Young
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Matabuena M, Salgado FJ, Nieto-Fontarigo JJ, Álvarez-Puebla MJ, Arismendi E, Barranco P, Bobolea I, Caballero ML, Cañas JA, Cárdaba B, Cruz MJ, Curto E, Domínguez-Ortega J, Luna JA, Martínez-Rivera C, Mullol J, Muñoz X, Rodriguez-Garcia J, Olaguibel JM, Picado C, Plaza V, Quirce S, Rial MJ, Romero-Mesones C, Sastre B, Soto-Retes L, Valero A, Valverde-Monge M, Del Pozo V, Sastre J, González-Barcala FJ. Identification of Asthma Phenotypes in the Spanish MEGA Cohort Study Using Cluster Analysis. Arch Bronconeumol 2023; 59:223-231. [PMID: 36732158 DOI: 10.1016/j.arbres.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The definition of asthma phenotypes has not been fully established, neither there are cluster studies showing homogeneous results to solidly establish clear phenotypes. The purpose of this study was to develop a classification algorithm based on unsupervised cluster analysis, identifying clusters that represent clinically relevant asthma phenotypes that may share asthma-related outcomes. METHODS We performed a multicentre prospective cohort study, including adult patients with asthma (N=512) from the MEGA study (Mechanisms underlying the Genesis and evolution of Asthma). A standardised clinical history was completed for each patient. Cluster analysis was performed using the kernel k-groups algorithm. RESULTS Four clusters were identified. Cluster 1 (31.5% of subjects) includes adult-onset atopic patients with better lung function, lower BMI, good asthma control, low ICS dose, and few exacerbations. Cluster 2 (23.6%) is made of adolescent-onset atopic asthma patients with normal lung function, but low adherence to treatment (59% well-controlled) and smokers (48%). Cluster 3 (17.1%) includes adult-onset patients, mostly severe non-atopic, with overweight, the worse lung function and asthma control, and receiving combination of treatments. Cluster 4 (26.7%) consists of the elderly-onset patients, mostly female, atopic (64%), with high BMI and normal lung function, prevalence of smokers and comorbidities. CONCLUSION We defined four phenotypes of asthma using unsupervised cluster analysis. These clusters are clinically relevant and differ from each other as regards FEV1, age of onset, age, BMI, atopy, asthma severity, exacerbations, control, social class, smoking and nasal polyps.
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Affiliation(s)
- Marcos Matabuena
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), University of Santiago of Compostela, Santiago de Compostela, Spain
| | - Francisco Javier Salgado
- Department of Biochemistry and Molecular Biology, School of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela, Santiago de Compostela, Spain; Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Juan José Nieto-Fontarigo
- Department of Biochemistry and Molecular Biology, School of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela, Santiago de Compostela, Spain; Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain; Department of Experimental Medical Science, Lund University, Sweden.
| | | | - Ebymar Arismendi
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Pilar Barranco
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Irina Bobolea
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María L Caballero
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - José Antonio Cañas
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Blanca Cárdaba
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - María Jesus Cruz
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Cellular Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain; Pneumology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Elena Curto
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Juan Alberto Luna
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Carlos Martínez-Rivera
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology Service, Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Joaquim Mullol
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Ear, Nose and Throat (ENT) Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Muñoz
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Cellular Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain; Pneumology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Javier Rodriguez-Garcia
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José María Olaguibel
- Allergology Department, Navarre University Hospital, Pamplona, Navarra, Spain; Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain
| | - César Picado
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Vicente Plaza
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Santiago Quirce
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Manuel J Rial
- Allergology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Beatriz Sastre
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Lorena Soto-Retes
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Valero
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Marcela Valverde-Monge
- Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Victoria Del Pozo
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Joaquín Sastre
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Francisco Javier González-Barcala
- Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain; Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Spain; Department of Medicine, University of Santiago de Compostela, Spain
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Mareque M, Climente M, Martinez-Moragon E, Padilla A, Oyagüez I, Touron C, Torres C, Martinez A. COST-EFFECTIVENESS OF BENRALIZUMAB VERSUS MEPOLIZUMAB AND DUPILUMAB IN PATIENTS WITH SEVERE UNCONTROLLED EOSINOPHILIC ASTHMA IN SPAIN. J Asthma 2022; 60:1210-1220. [PMID: 36322679 DOI: 10.1080/02770903.2022.2139718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of benralizumab (benra) vs. mepolizumab (mepo) and dupilumab (dupi) for the treatment of patients with severe uncontrolled asthma from the Spanish Health System perspective. METHODS Exacerbations avoided, quality-adjusted life years (QALYs) gained and costs in a 5-year period were estimated with a Markov model for a cohort of 1,000 patients in which, based on published evidence, 31% of the patients received biologics + oral corticosteroids (OCS) and 69% received only biologics. Efficacy data (exacerbation reduction and OCS elimination) were derived from a matching-adjusted indirect comparison. Published EQ-5D utilities per health state (biologic alone, biologic + OCS, standard of care + OCS, exacerbations, and post-exacerbations) were used for QALY estimation. Utility decrements associated with exacerbation management [-0.1 (OCS or emergency visits), -0.2 (hospitalization)] derived from the literature were applied. Costs (€, 2022) included drug acquisition (ex-factory price), administration and disease management. An expert panel (2 pneumologists and 1 pharmacist) validated all inputs. RESULTS Benra was more effective (52.21 QALYs) than mepo (51.39 QALYs) and dupi (51.30 QALYs). Benra avoided more exacerbations (2.87 exacerbations) compared to mepo (4.70 exacerbations) and dupi (5.11 exacerbations) for the 5-year horizon. Total costs/patient were €56,093.77 (benra), €59,280.45 (mepo) and €62,991.76 (dupi), resulting in benra dominating (more QALYs with lower costs) vs. mepo and dupi. CONCLUSIONS Benralizumab can be considered as a dominant treatment alternative vs. other biologic drugs for the treatment of uncontrolled severe eosinophilic asthma patients in Spain.
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Affiliation(s)
- M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - M Climente
- Hospital Universitario Doctor Peset, Valencia, Spain
| | | | | | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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