Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0146003
Title: Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma
Authors: Zafari, Zafar
Sadatsafavi, Mohsen
Marra, Carlo A
Chen, Wenjia 
FitzGerald, J Mark
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
ANTI-IGE ANTIBODY
ADD-ON THERAPY
SEVERE PERSISTENT
UNCONTROLLED ASTHMA
HEALTH
ADULTS
SAFETY
EFFICACY
CORTICOSTEROIDS
EXACERBATIONS
Issue Date: 11-Jan-2016
Publisher: PUBLIC LIBRARY SCIENCE
Citation: Zafari, Zafar, Sadatsafavi, Mohsen, Marra, Carlo A, Chen, Wenjia, FitzGerald, J Mark (2016-01-11). Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma. PLOS ONE 11 (1). ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0146003
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 moderateto- 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.
Source Title: PLOS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/226813
ISSN: 19326203
DOI: 10.1371/journal.pone.0146003
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