title: Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma.
abstract: BACKGROUND
  Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of standard therapy, BT, and omalizumab for moderate-to-severe allergic asthma in the USA.
  
  
  METHODS
  A probabilistic Markov model with weekly cycles was developed to reflect the course of asthma progression over a 5-year time horizon. The study population was adults with moderate-to-severe allergic asthma whose asthma remained uncontrolled despite using high-dose inhaled corticosteroids (ICS, with or without long-acting beta-agonists [LABA]). A perspective of the health-care system was adopted with asthma-related costs as well as quality-adjusted life years (QALYs) and exacerbations as the outcomes.
  
  
  RESULTS
  For standard therapy, BT, and omalizumab, the discounted 5-year costs and QALYs were $15,400 and 3.08, $28,100 and 3.24, and $117,000 and 3.26, respectively. The incremental cost-effectiveness ratio (ICER) of BT versus standard therapy and omalizumab versus BT was $78,700/QALY and $3.86 million/QALY, respectively. At the willingness-to-pay (WTP) of $50,000/QALY and $100,000/QALY, the probability of BT being cost-effective was 9%, and 67%, respectively. The corresponding expected value of perfect information (EVPI) was $155 and $1,530 per individual at these thresholds. In sensitivity analyses, increasing the costs of BT from $14,900 to $30,000 increased its ICER relative to standard therapy to $178,000/QALY, and decreased the ICER of omalizumab relative to BT to $3.06 million/QALY. Reducing the costs of omalizumab by 25% decreased its ICER relative to BT by 29%.
  
  
  CONCLUSIONS
  Based on the available evidence, our study suggests that there is more than 60% chance that BT becomes cost-effective relative to omalizumab and standard therapy at the WTP of $100,000/QALY in patients with moderate-to-severe allergic asthma. However, there is a substantial uncertainty in the underlying evidence, indicating the need for future research towards reducing such uncertainty.
authors.affiliation: Institute for Heart and Lung Health (IHLH), Faculty of Medicine, University of British Columbia, Vancouver, Canada.|Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, Canada.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Zafari
authors.affiliation: Institute for Heart and Lung Health (IHLH), Faculty of Medicine, University of British Columbia, Vancouver, Canada.|Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, Canada.|Respiratory Medicine Division, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Marra
authors.affiliation: Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Chen
authors.affiliation: Institute for Heart and Lung Health (IHLH), Faculty of Medicine, University of British Columbia, Vancouver, Canada.|Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, Canada.|Respiratory Medicine Division, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: FitzGerald
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D001980:Bronchi / Q000187:drug effects / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D000069444:Omalizumab / Q000191:economics* / Q000627:therapeutic use; D011446:Prospective Studies; D061208:Pulsed Radiofrequency Treatment / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000069444:Omalizumab