Impact of benralizumab on asthma exacerbation-related medical healthcare resource utilization and medical costs: results from the ZEPHYR 2 study

Abstract

Background and Aim

Benralizumab is a biologic add-on treatment for severe eosinophilic asthma that can reduce the rate of asthma exacerbations, but data on the associated medical utilization are scarce. This retrospective study evaluated the economic value of benralizumab by analyzing healthcare resource utilization (HRU) and medical costs in a large patient population in the US.

Methods

Insurance claims data (11/2016–6/2020) were analyzed. A pre-post design was used to compare asthma exacerbation rates, medical HRU and medical costs in the 12 months pre vs. post index (day after benralizumab initiation). Patients were aged ≥12 years, with ≥2 records of benralizumab and ≥2 asthma exacerbations pre index, and constituted non-mutually exclusive cohorts: biologic-naïve, biologic-experienced (switched from omalizumab or mepolizumab to benralizumab), or with extended follow-up (18 or 24 months).

Results

In all cohorts (mean age 51–53 years; 67–70% female; biologic-naïve, N = 1,292; biologic-experienced, N = 349; 18-month follow-up, N = 419; 24-month follow-up, N = 156), benralizumab treatment reduced the rate of asthma exacerbation by 53–68% (p < .001). In the biologic-naïve cohort, inpatient admissions decreased by 58%, emergency department visits by 54%, and outpatient visits by 58% post index (all p < .001), with similar reductions in exacerbation-related medical HRU in other cohorts. Exacerbation-related mean total medical costs decreased by 51% in the biologic-naïve cohort ($4691 pre-index, $2289 post-index), with cost differences ranging from 16% to 64% across other cohorts (prior omalizumab: $2686 to $1600; prior mepolizumab: $5990 to $5008; 18-month: $3636 to $1667; 24-month: $4014 to $1449; all p < .001). Medical HRU and cost reductions were durable, decreasing by 64% in year 1 and 66% in year 2 in the 24 month follow-up cohort.

Conclusion

Patients treated with benralizumab with prior exacerbations experienced reductions in asthma exacerbations and exacerbation-related medical HRU and medical costs regardless of prior biologic use, with the benefits observed for up to 24 months after treatment initiation.

PLAIN LANGUAGE SUMMARY

Benralizumab is a biologic approved as an add-on treatment for severe eosinophilic asthma. Previous real-world studies and clinical trials have shown that benralizumab can reduce the rate of asthma exacerbations and systemic corticosteroid use. However, there is little information on the economic value of benralizumab in real-world patient populations. This study showed that patients with severe asthma in the United States had lower rates of asthma exacerbations after starting treatment with benralizumab. The patients also had fewer asthma exacerbation-related hospitalizations, emergency department visits, and outpatient visits as well as lower medical costs related to asthma exacerbations compared with before the treatment. These benefits were observed in patients who had never taken and those who had been previously treated with biologic therapies, and for up to 24 months after starting benralizumab treatment. These results show that the clinical value of benralizumab translates into reduced medical utilization for patients with severe asthma.

Keywords:

• Severe eosinophilic asthma
• biologic treatment
• healthcare resource utilization
• medical costs
• value-based medicine
• benralizumab

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I19
• I11

Transparency

Declaration of funding

AstraZeneca funded this study, and participated in the study design, data collection, data analysis, and data interpretation. AstraZeneca reviewed the publication, without influencing the opinions of the authors, to ensure medical and scientific accuracy, and the protection of intellectual property. The authors had access to all data in the study, and had the final responsibility for the decision to submit the manuscript for publication.

Declaration of financial/other relationships

DJM received consultant/speaker fees from AstraZeneca, GSK, Amgen, Sanofi/Regeneron.

FM, EC, DY, and KB are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to AstraZeneca, which funded the development and conduct of this study and manuscript. Joshua Young was an employee of Analysis Group, Inc. at the time this study was conducted.

DC and YC are employees of AstraZeneca and own stock/stock options in AstraZeneca.

EG was an employee of AstraZeneca at the time this study was conducted and owns stock/stock options in AstraZeneca.

Author contributions

YC: Conceptualization, Methodology, Formal analysis, Writing—original draft preparation, Writing—review and editing. DJM: Conceptualization, Methodology, Formal analysis, Writing—original draft preparation, Writing—review and editing. FM: Conceptualization, Methodology, Data validation, Formal analysis, Writing—original draft preparation, Writing—review and editing. EEC: Conceptualization, Methodology, Data validation, Formal analysis, Writing—original draft preparation, Writing—review and editing. DY: Data validation, Formal analysis, Writing—original draft preparation, Writing—review and editing. JAY: Data validation, Formal analysis, Writing—original draft preparation, Writing—review and editing. KAB: Conceptualization, Methodology, Formal analysis, Writing—original draft preparation, Writing—review and editing. EG: Conceptualization, Methodology, Formal analysis, Writing—review and editing. DC: Conceptualization, Methodology, Formal analysis, Writing—original draft preparation, Writing—review and editing.

All authors agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing assistance was provided by Janice Imai, an employee of Analysis Group, Inc., and funded by AstraZeneca.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Previous presentations

Part of the material in this manuscript was presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting held on November 4–8, 2021 in New Orleans, LA, USA; American Academy of Allergy Asthma & Immunology Annual Meeting held on February 25–28, 2022 in Phoenix, AZ, USA; Eastern Allergy Conference held on June 2–5, 2022 in Palm Beach, FL, USA; and CHEST Annual Meeting held on October 16–19, 2022 in Nashville, TN, USA as a poster presentation.