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. 2016 Jan 11;11(1):e0146003.
doi: 10.1371/journal.pone.0146003. eCollection 2016.

Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma

Zafar Zafari  1   2 , Mohsen Sadatsafavi  1   2   3 , Carlo A Marra  4 , Wenjia Chen  5 , J Mark FitzGerald  1   2   3
Affiliations

Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma

Zafar Zafari et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have the following interests: J. Mark FitzGerald received a grant from Allergen. His relevant financial activities outside of the present work are from GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Boehringer-Ingelheim, Altana, Merck, and Topigen. Carlo A. Marra's relevant financial activities outside of the present work are from GlaxoSmithKline, Pfizer, Boehringer-Ingelheim, and Abbvie. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Schematic Markov states.
Health states include: exacerbation-free, exacerbation states: exacerbation requiring oral corticosteroids, emergency room visit, hospitalizations, and death state.
Fig 2
Fig 2. (A) Cost-effectiveness plane; (B) Cost-effectiveness acceptability curve; and (C) Expected value of information.
Fig 3
Fig 3. One-way sensitivity analysis: (A) BT versus standard therapy, (B) omalizumab versus BT.
Fig 4
Fig 4. Sensitivity analysis for the costs of BT.
Incremental cost-effectiveness ratio as a function of BT’s cost: (A) BT versus standard therapy, (B) omalizumab versus BT.
See this image and copyright information in PMC

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