The costs and consequences of omalizumab in uncontrolled asthma from a USA payer perspective.
BACKGROUND
Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective.


METHODS
We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment.


RESULTS
The mean lifetime discounted costs and QALYs were $83,400 and 13.87 for usual care and $174,500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219,300, $557, 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition.


CONCLUSIONS
The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment.
Department of Clinical Pharmacy, University of Colorado Denver, Aurora, CO, USA. Jon.Campbell@ucdenver.edu
J D
JD
Campbell
D E
DE
Spackman
S D
SD
Sullivan
D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000191:economics* / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001249:Asthma / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000503:physiopathology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D000069444:Omalizumab; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States
D000305:Adrenal Cortex Hormones; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C026408:anti-IgE antibodies; D000069444:Omalizumab