Economic considerations on the usage of biologics in the allergy clinic

Abstract

The introduction of biologic drugs and their expanding use over the last years have transformed the management of patients suffering from severe atopic diseases. Unfortunately, their very high cost also creates new challenges in terms of access and sustainability. This is a problem shared among all medical disciplines. In Europe, the 10 most prescribed biologics accounted for a combined cost of 16.5 billion Euros (14.8 billion USD). 1 In the USA in 2013, they were found to account for 40% of medication costs while representing only 2% of prescription. 2 To evaluate the value and justify coverage of new medications, industry and health technology agencies perform cost-utility analyses, which are the cornerstone of health economic assessment. 3-6 When used within their limits, they can be powerful tools to allow fair comparison of seemingly incomparable health states. Many clinicians feel they have insufficient training to properly interpret health economics studies. 7,8 This is paradoxical since clinicians are often in the best position to judge the credibility of baseline hypotheses, the appropriateness of treatment goals and the applicability to specific patient context and should in fact play a central role in the critical appraisal of such analyses. The objective of this review is to provide key notions to help allergists assess literature on health economics, review and compare available cost-utility studies on the use of biologic drugs in the field of allergy, and reflect on unmet needs and future directions in this area.

Cost–Utility Analysis of Dupilumab for the Treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in Italy

“…The introduction of biologic drugs and their expanding use over the past few years have transformed the management of patients suffering from severe atopic diseases. Unfortunately, their higher price also creates new challenges in terms of access and sustainability [ 47 ]. However, dupilumab proved to be a new therapy with an affordable increase in terms of costs compared to the current standard of care.…”

Advances and highlights in asthma in 2021

“…Unfortunately, current analyses of cost‐effectiveness conducted for the use of biologicals in asthma provide variable results. Multi‐criteria decision analysis (MCDA) is an emerging approach where results of economic analyses are included in a comprehensive data matrix organized by criteria, along with all relevant clinical, contextual, experiential and ethical data 112 . An interesting study using a cohort state‐transition model (Markov model) evaluated the potential consequences in costs and health‐related quality of life of the evaluated strategies in the clinical pathway of asthmatic patients over a 10‐year time horizon.…”

Mapping the Food Allergy Quality of Life Questionnaire Parent Form onto the Short‐Form Six‐Dimensions version 2

“…questionnaires that have been previously validated in the population of interest using direct elicitation methods (e.g., standard gamble, time trade-off, discrete choice experiment). 7,9 The only questionnaire for which a utility preference set has been specifically elicited in the food allergic population is the Short-Form Six-Dimension version 2 (SF-6Dv2), which defines health states according to 6 dimensions: physical functioning, role limitation, pain, emotional impact, social limitations, and vitality. 10 Its main limitation is that it is a generic questionnaire, and thus inevitably lacks the precision and sensitivity of a disease-specific questionnaire to capture subtle and relevant disease-specific changes in food allergy HRQoL.…”

“…In health economics, HRQoL is measured using health utility values and the validity of cost-utility analysis is directly dependent on their proper estimation. 7,8 Utility expresses the value given to life lived in a given health state from 0 to 1, using perfect health (utility of 1) and death (utility of 0) as anchor values (Table 1). Individual patient utility values are typically derived from generic health-related…”

“…Utility expresses the value given to life lived in a given health state from 0 to 1, using perfect health (utility of 1) and death (utility of 0) as anchor values (Table 1). Individual patient utility values are typically derived from generic health‐related questionnaires that have been previously validated in the population of interest using direct elicitation methods (e.g., standard gamble, time trade‐off, discrete choice experiment) 7,9 …”