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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Cost Effectiveness and Resource Allocation 1/2018

Cost-effectiveness of tiotropium versus omalizumab for uncontrolled allergic asthma in US

Zeitschrift:
Cost Effectiveness and Resource Allocation > Ausgabe 1/2018
Autoren:
Zafar Zafari, Mohsen Sadatsafavi, J. Mark FitzGerald, for the Canadian Respiratory Research Network
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12962-018-0089-8) contains supplementary material, which is available to authorized users.

Abstract

Background

A significant minority of asthma patients remain uncontrolled despite the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). A number of add-on therapies, including monoclonal antibodies (namely omalizumab) and more recently tiotropium bromide have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of tiotropium versus omalizumab as add-on therapies to ICS + LABA for patients with uncontrolled allergic asthma.

Methods

A probabilistic Markov model of asthma was created. Total costs (in 2013 US $) and health outcomes of three interventions including standard therapy (ICS + LABA), add-on therapy with tiotropium, and add-on therapy with omalizumab, were calculated over a 10-year time horizon. Future costs and quality-adjusted life years (QALYs) were discounted at the rate of 3%. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at willingness-to-pay value of $50,000.

Results

The 10-year discounted costs and QALYs for standard therapy were $38,432 and 6.79, respectively. The corresponding values for add-on therapy with tiotropium and with omalizumab were $41,535 and 6.88, and $217,847 and 7.17, respectively. The incremental cost-effectiveness ratios (ICER) of add-on therapy with tiotropium versus standard therapy, and omalizumab versus tiotropium were $34,478/QALY, and $593,643/QALY, respectively. The model outcomes were most sensitive to the costs of omalizumab but were robust against other assumptions.

Conclusions

Although omalizumab had the best health outcomes, add-on therapy with tiotropium was a cost-effective alternative to omalizumab and standard therapy for uncontrolled allergic asthma at willingness-to-pay of $50,000/QALY.
Zusatzmaterial
Additional file 1: Appendix S1. Estimating the transition probabilities for add-on therapy with omalizumab. Appendix S2. Estimating the medication costs per level of control.
Literatur
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