An evaluation of the cost‐effectiveness of omalizumab for the treatment of severe allergic asthma

Abstract

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.

Omalizumab in the management of patients with allergic (IgE-mediated) asthma

“…The daily cost to achieve each additional day in which asthma was controlled was $523, while the daily cost of a ≥0.5-point increase in Asthma Quality of Life Questionnaire score was $378 (US$ values from 2003) 85. In their review, Sullivan and Turk noted that these measures of cost-effectiveness were more difficult to interpret than incremental costs per QALY as a guide to resourcing decisions 84. They also noted that this analysis used data from a less severe patient population and did not take account of the patients’ responses to omalizumab at 16 weeks 84…”

“…However, as Sullivan and Turk note, the model of Wu et al was based on a population with severe asthma, but used data from patients with mild-to-severe asthma and remains to be validated in patients with more severe disease 84. Additionally, one of the main components of this analysis was health-related quality of life, which is based on prediction of FEV 1 .…”

The unbearable cost of severe asthma in underprivileged populations

“…As a chronic illness, asthma has a major impact on the life of the individual as well as the family, and the economic burden of asthma is high (2), in particular among uncontrolled asthmatics (3)(4)(5). Most studies on the cost of asthma focused on direct and indirect costs to the health system (6). However, direct expenditures incurred by the families of subjects with asthma are often overwhelming.…”

Anti-IgE for the Treatment of Allergic Rhinitis – and Eventually Nasal Polyps?

“…To address these questions, further studies have to be conducted. However, omalizumab was found to be cost-effective in the treatment of patients with inadequately controlled severe persistent allergic asthma compared with treatment with high-dose inhaled corticosteroids plus a long-acting β 2 -agonist [57]. …”