1 - HE&OR Senior Researcher, ISBE
2 - Serviço de Pneumologia, Centro Hospitalar Universitário de Coimbra
3 - Serviço de Pneumologia, Hospital Pedro Hispano
4 - Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Central
- ISPOR 2022
Objectives: Dupilumab, a first-in-class, monoclonal antibody that targets type-2 asthma, has been investigated in clinical trials, demonstrating significantly lower rates of severe asthma exacerbation, better lung function and asthma control. We aimed to assess cost-effectiveness of dupilumab (DUP) + background therapy (BT) as compared to other biologics+BT in adults and adolescents (>=12 years) with non-controlled persistent severe asthma in Portugal.
Methods: We built a Markov model with two treatment-related health states (each with five health substates – controlled/uncontrolled asthma, moderate/severe exacerbation and asthma-related death) and a other-cause death state, to estimate and compare effectiveness (life years), utility (QALY) and costs (€) of DUP+BT versus BT, mepolizumab, reslizumab (adults), benralizumab (adults), and omalizumab (increased IgE), all plus BT. Clinical data from pivotal double-blind randomized clinical trials using indirect treatment comparisons . Health state utilities based on EQ-5D-5L clinical trial and registry data considering Portuguese tariffs. Direct medical costs (drug acquisition and administration, disease management, exacerbations, adverse events) based on literature, expert opinion and official public sources. Base-case analysis conducted for the perspective of National Health Service (NHS), over lifetime horizon, 4% annual discount rate, and costs expressed in 2021 euros.
Results: From our model, over a lifetime horizon, DUP+BT results in a lower number of severe exacerbations and consequently in less asthma-related deaths and longer life expectancy versus other biologics. A patient treated with DUP+BT is expected to gain on average 0.09-0.69 QALY (omalizumab-benralizumab) versus other biologics+BT. Moreover, over lifetime, Portuguese NHS may save up around €14,000-30,000 (mepolizumab-omalizumab) per patient treated with DUP+BT versus other biologics+BT, over lifetime.
Discussion: In our analysis, dupilumab is dominant as compared with other biologics used in the treatment of severe asthma in adults and adolescents in Portugal. Confidential drug price of biologics and lack of head-to-head trials may be limitations of this analysis.
Palavras Chave: dupilimab, severe asthma