The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review

Abstract

Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.

Impulse Oscillometry, Small Airways Disease, and Extra-Fine Formulations in Asthma and Chronic Obstructive Pulmonary Disease: Windows for New Opportunities

“…Finally, a systematic review by Menzella et al, 54 exploring the pharmacoeconomic aspects in asthma treatment, highlighted the optimization of pharmaceutical expenses thanks to controller medications and innovative therapies and the increase in prescriptive appropriateness (which translated into evident saving on hospitalizations). The authors also conclude stressing the need for accurate phenotyping and identification of predictors of response.…”

“…The authors also conclude stressing the need for accurate phenotyping and identification of predictors of response. 54 …”

Inhibition of γ-glutamyl transferase suppresses airway hyperresponsiveness and airway inflammation in a mouse model of steroid resistant asthma exacerbation

“…Currently, there has been an influx of biologic treatments for asthma targeting cytokines that are notable drivers for asthma exacerbation, such as tezepelumab (anti-TSLP), astegolimab (anti-ST2), itepekimab (anti-IL-33), and risankezumab (anti-IL-23) (7)(8)(9)(10). While there has been some success in employing these biologic agents as stand-alone therapies or add-ons to glucocorticoids, issues regarding the high cost of these therapeutics remain to be a barrier to access (11). Furthermore, most biologic therapies are tailored towards type 2 immune factors (namely TSLP, IL-5, and IL-4R), and biologics developed for non-Th2 driven exacerbations (e.g.…”

Bronchoconstriction damages airway epithelia by crowding-induced excess cell extrusion

“…In fact, a bronchoconstrictive response to methacholine (MCH) challenge is the standard diagnostic test for asthma ( 2 ). Current therapies include albuterol, a short-acting β2 adrenergic receptor agonist that relaxes airway smooth muscle (ASM) to relieve constriction, and inhaled corticosteroids, which reduce eosinophilic and type 2 airway inflammation ( 3 ). Although these therapies help, many patients continue to experience poor symptom control and airway hyperresponsiveness.…”