Cost-Effectiveness of Anti-Immunoglobulin E Biologic Therapy for Severe Asthma

Roughly 38% of patients with severe asthma do not respond to complementary anti-immunoglobulin E (IgE) therapy, which leads to higher costs of treatment, investigators reported in the World Allergy Organization Journal.

The 2-year retrospective cohort study was conducted in 2018 and 2019 at a hospital in Mexico City, Mexico. The participants were adult patients (aged 18 to 75 years) who met the criteria for severe asthma according to the Global Initiative for Asthma (GINA).

The researchers assessed the patients’ direct costs of treatment, which included pharmacologic treatment, clinical tests, days of hospitalization, admissions to the emergency room, and scheduled consultations. The participants were classified as having controlled severe asthma (CSA; defines as no exacerbations during the year in question) or uncontrolled severe asthma (UCSA; defined as at least 1 exacerbation during the year).

A total of 60 patients (median age, 56 years; 51 women) were included. The patients received complementary anti-IgE biologic treatment with omalizumab, given subcutaneously every month. Standard treatments included corticosteroids, leukotriene modifiers, antihistamines, antibiotics, and a combination of drugs.

In 2018, 23 patients (38.3%) had UCSA (exacerbations: median, 1.5; maximum, 3). In 2019, 22 patients (36.7%) had UCSA (exacerbations: median, 1.5; maximum, 6). Among the 60 patients, 12 (20%) had exacerbations in the 2-year study period (median, 3; minimum, 2; maximum, 9) after 4 to 10 years (median, 7.8) of complementary therapy.

The cost for all patients with severe asthma from 2018 to 2019 was $993,289.60 ($482,068.70 in 2018 and $511,220.90 in 2019). About 100% of this cost was associated with drug treatment expenses and scheduled consultations. The mean cost per patient in this same period was $16,301.10. The cost was slightly but significantly higher for those with UCSA ($16,392) compared with those who had CSA ($16,246; P =.02).

The number of exacerbations was most influential variable on total cost during the 2 years, with an increase of $350 per exacerbation, according to the generalized linear model.

Study limitations include the limited use of biologic therapy for asthma, which only consisted of anti-IgE therapy with omalizumab. Another limitation is the low number of patients with markers, such as IgE and eosinophils, of the key pathogenic pathways, which prevented a further analysis regarding the number of exacerbations and the values of these markers owing to the lack of statistical power.

“We strongly recommend the evaluation of adequate biologic markers to achieve greater precision in the phenotypic diagnosis of asthma and, therefore, a more efficient therapy for patients with low asthma control,” stated the investigators. “Personalizing treatments within the same cohort under GINA guidelines would be beneficial for the patient’s health and, at the same time, increase cost-effectiveness in the public health system.”

Disclosure: One of the study authors declared an affiliation with a pharmaceutical company. Please see the original reference for a full list of authors’ disclosures.

Reference

López-Tiro J, Contreras-Contreras A, Rodríguez-Arellano ME, Costa-Urrutia P. Economic burden of severe asthma treatment: a real-life study. World Allergy Organ J. Published online July 4, 2022. doi:10.1016/j.waojou.2022.100662