This study demonstrates that add-on omalizumab therapy is cost-effective in patients with severe persistent allergic asthma.

Co-morbid conditions experienced by older asthma patients may contribute to mortality post an asthma admission and greater understanding of risk factors contributing to fatality are required.

Based on the model and the assumptions used, our results suggest that omalizumab provides cost offsets, improves quality of life and may have an attractive ICER in treating the severe allergic asthma population.

Omalizumab is the first licensed anti‐immunoglobulin (Ig) E antibody shown to be effective for treatment of allergic (IgE‐mediated) asthma. Recent international guidelines recommend omalizumab as add‐on treatment to fixed dose inhaled corticosteroid (ICS) and long‐acting β2‐agonist (LABA) combination therapy. However, omalizumab is more expensive than other current asthma treatments and health and reimbursement authorities are increasingly demanding evidence of economic benefit to support pricing and formulary listing. The aims of this article are to (i) summarize data on the human and economic burden of severe asthma, (ii) summarize the efficacy data obtained for omalizumab in clinical trials in patients with inadequately controlled severe persistent allergic asthma despite high‐dose ICS plus a LABA, and (iii) discuss the cost‐effectiveness evidence published for omalizumab in this patient population. A wealth of evidence exists highlighting that the health, economic and societal burden of asthma is considerable and is highly skewed towards patients with severe asthma, particularly when asthma is inadequately controlled. Omalizumab is clinically beneficial in patients with severe persistent allergic asthma despite high‐dose ICS plus a LABA, particularly in a subgroup of patients who respond to therapy. In patients who respond to therapy, the cost‐effectiveness of omalizumab compares well with other biologic treatments for chronic illness.

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In patients with inadequately controlled severe persistent asthma, day-to-day symptoms correlate well with QoL. Add-on omalizumab significantly improves day-to-day symptoms compared with placebo. Further improvement in responders confirms the physician's assessment as a response measure.

The range of utility values (0.71-0.78) demonstrates the severity of moderate to severe allergic asthma. However the spread of scores between complete control of asthma and worsening of asthma was lower than was expected. The community sample placed only a moderate value on the avoidance of all asthma symptoms in the DCE survey. The results suggest that the community sample may not have fully understood the benefits of control over asthma symptoms and the limitations such symptoms can impose on everyday life.

Summary Objectives:  This study was designed to report factors associated with asthma hospital admission, such as patient characteristics, type of admission and subsequent outcome i.e. discharge or death, for the years 2000–2005. These data are used for health economic models regarding asthma burden in the hospital setting in Australia. Methods:  Data was obtained from the Australian Centre for Asthma Monitoring using their amalgamated dataset from all states and territories. Admissions under ICD‐10 codes J45 ‘Asthma’ plus all subcodes, and J46 ‘acute severe asthma’ were included. Codes for associated comorbidity at the time of admission were identified, as well as the month of death, age, gender and length and the type of stay. Confidence intervals for death rate assumed a binomial distribution because of the rarity of event. Results:  The total number of all‐cause deaths for the 5‐year observation period was 289 from 202,739 asthma separations or 0.14% or 143 deaths/100,000 separations and the highest rate was seen in patients over 45 years. Acute upper respiratory tract infections were reported in up to 25% of all asthma hospital admissions. Length of stay was up to a mean average of 10.2 days in patients who died (SD 15.3). In 5 years observation there was 152,758 emergency asthma admissions which contributed greatly to Australian healthcare burden. Conclusions:  The study demonstrates that emergency admissions dominate asthma care in the hospital setting in Australia, which suggests poor asthma control in some patients with subsequent economic burden. Asthma‐related mortality remains a risk for specific patients in the hospital setting.