Cost-effectiveness analysis of dupilumab among patients with oral corticosteroid-dependent uncontrolled severe asthma in Japan

Abstract

Background

Asthma is a common, chronic inflammatory airway disorder, with up to 1,177,000 people receiving asthma treatment in Japan. Dupilumab is a first-in-class, monoclonal antibody for the treatment of atopic diseases, including persistent asthma. The objective of this study was to assess the cost-effectiveness of dupilumab, compared with other biologics, as add-on treatment to background therapy in patients aged ≥12 years with uncontrolled, persistent asthma in Japan.

Methods

A life-time Markov cohort model was used to conduct cost-effectiveness analysis from the Japanese healthcare payer perspective with an annual discount rate of 2%. Dupilumab was compared with benralizumab and mepolizumab, and against omalizumab (as a hypothetical scenario). Inputs were informed by dupilumab clinical trials (VENTURE [NCT02528214] and QUEST [NCT02414854] trials), the literature, official Japanese sources and expert opinions.

Results

The base case results suggest that treatment with dupilumab leads to fewer severe exacerbations and increased life-years (LYs) and quality-adjusted LYs (QALYs) than benralizumab and mepolizumab. At a willingness-to-pay (WTP) threshold of ¥5,000,000 per QALY gained, dupilumab was the dominant strategy (lower cost, increased QALYs) versus benralizumab, and cost-effective versus mepolizumab with an incremental cost-effectiveness ratio (ICER) of ¥1,010,921 (US$9,190, US$1 = ¥110). Versus omalizumab, dupilumab was not cost-effective (ICER of ¥10,802,368 [US$98,203]).

Conclusions

In Japan, dupilumab, as an add-on to background therapy, is economically dominant compared with benralizumab, and cost-effective versus mepolizumab.

Keywords:

• Asthma
• biologics
• dupilumab
• cost-effectiveness
• Japan

Acknowledgements

Anna Tytula and Yitong Wang of Creativ-Ceutical provided technical support.

Authors’ contributions

YTa and MM had planned this study. YTo, HM, MM, YTa, MU, FJ, and IA have contributed to the conduct of the study, data collection, interpretation of the study results, and development of the manuscript. All authors gave approval on the submission of the manuscript.

Declaration of interest

YTo has received honoraria from AstraZeneca K.K., Kyorin Pharmaceutical Co., Ltd., and Sanofi K.K. HM has received honoraria from AstraZeneca K.K., Kyorin Pharmaceutical Co., Ltd., GlaxoSmithKline K.K., Novartis Pharma K.K. and Sanofi K.K and research funding from Novartis Pharma K.K. YTo, HM and IA had received consultancy fees from Sanofi K.K. for this study. IA is a chairperson of the society for pharmacoeconomics and YTa is a councilor of ISPOR-Japan. MM, YTa and FJ are Sanofi employees and may hold shares and/or stock options in the company. All authors respect the Ethical Guidelines for Medical and Health Research Involving Human Subjects.

Data availability statement

All data supporting the findings of this study are available within the article and its supplementary materials.

Additional information

Funding

This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. and Creativ-Ceutical was paid for conducting the study and providing the medical writing support. All authors had full access to all data in this study and took complete responsibility for the integrity of the data and accuracy of the data analysis. Costs for article processing and Open Access were also funded by the study sponsors.