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ABSTRACT
Background
Cost-effectiveness studies evaluate health technologies and help choose treatments. The current study compared dupilumab to omalizumab, mepolizumab, and benralizumab in Colombian adults with severe uncontrolled type 2 asthma.
Methods
Over a 5-year period, a Markov model was utilized to assess the costs of biological treatments and management of exacerbations, comparing various doses of exacerbations, comparing various doses of dupilumab, omalizumab, mepolizumab, and benralizumab as add-on treatments. It included a 5% annual discount rate per local HTA, and set willingness-to-pay at three times GDP per capita per quality-adjusted life year (QALY) in Colombia.
Results
Dupilumab (200 mg) exhibited greater QALYs and reduced overall costs compared to mepolizumab (100 mg), benralizumab (30 mg), and omalizumab (450 mg and 600 mg), with the incremental cost-effectiveness ratio (ICER) per QALYgained being -$5.429, -$6.269, -$196.567 and -$991.007, respectively. Dupilumab had greater QALYs and costs versus omalizumab 300 mg (ICERof $200.653 per QALY, above the willingness-to-pay threshold of 3 × GDP per capita). Sensitivity analyses were consistent with base case results.
Conclusions
Dupilumab 200 mg was strongly dominant versus omalizumab 450 mg and 600 mg, mepolizumab 100 mg, and benralizumab 30 mg; however, cost-effectiveness was not demonstrated versus omalizumab 300 mg. These results could assist healthcare professionals in choosing an appropriate biologic for treating severe type 2 asthma.
Declaration of interest
A Ali serves as advisor board member and reports grands and/or other fees from Novartis, Glenmark, GSK, Cipla, Boehringer-Ingelheim, AstraZeneca, Sanofi. E García serves as advisor board member, speaker, and reports grands and/or other fees from Novartis, AstraZeneca, Sanofi, and GSK. C A Torres-Duque serves as advisor board member, speaker, consultant, and report grands and/or other fees from AstraZeneca Colombia, Boehringer-Ingelheim, Genzyme, GSK, Janssen Pharmaceuticals, MSD, Novartis and Sanofi. As research director from the Fundación Neumológica Colombiana has developed institutional activities with grants and/or other fees from AstraZeneca Colombia, Bayer, Boehringer-Ingelheim, Pfizer, Gilead Sciences, GSK, MSD, Novartis and Sanofi. D Rey serves as local advisor, consultant, speaker, and reports grands and/or other fees from Boehringer-Ingelheim, Novartis, Roche, AstraZeneca, Sanofi, GSK, and Amarey. S Londoño, S Saenz, M P Avila, E Mazo, L Botero are employees of Sanofi Colombia, and may hold shares and/or stock options in the company. None of the authors have relationships with the tobacco industry. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Acknowledgments
We wish to thank Diego Nivia, Florence Joulain, and Avinash Thakur for their review, editorial assistance, and valuable comments of this paper.
Author contributions
Concept and design: A Ali, E García, C A Torres-Duque, D Rey, S Londoño, L Botero, E Mazo, S Saenz. Acquisition of data: S Londoño, L Botero, E Mazo, M P Avila, S Saenz. Analysis and interpretation of data: S Londoño, S Saenz, L Botero, E Mazo. Drafting of the manuscript: S Londoño, S Saenz, M P Avila, E Mazo, L Botero. Critical revision of the paper for important intellectual content: A Ali, E García, C A Torres-Duque, D Rey, S Londoño, S Saenz, L Botero, E Mazo, M P Avila. Statistical analysis: S Londoño, S Saenz, L Botero. Supervision: S Londoño, L Botero, M P Avila.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Concept and design: Abraham Ali, Elizabeth García, Carlos A Torres-Duque, Diana Rey, Sergio Londoño, Laura Botero, EM, Stid Saenz.
Acquisition of data: Sergio Londoño, Laura Botero, Elizabeth Mazo, Maria Paula Avila, Stid Saenz.
Analysis and interpretation of data: Sergio Londoño, Stid Saenz, Laura Botero, Elizabeth Mazo.
Drafting of the manuscript: Sergio Londoño, Stid Saenz, Maria Paula Avila, Elizabeth Mazo, Laura Botero.
Critical revision of the paper for important intellectual content: Abraham Ali, Elizabeth García, Carlos A Torres-Duque, Diana Rey, Sergio Londoño, Stid Saenz, Laura Botero, Elizabeth Mazo, Maria Paula Avila.
Statistical analysis: Sergio Londoño, Stid Saenz, Laura Botero.
Supervision: Sergio Londoño, Laura Botero, Maria Paula Avila.
Conflict of interest disclosures
Abraham Ali serves as advisor board member and reports grands and/or other fees from Novartis, Glenmark, GSK, Cipla, Boehringer-Ingelheim, AstraZeneca, Sanofi. Elizabeth García serves as advisor board member, speaker, and reports grands and/or other fees from Novartis, AstraZeneca, Sanofi, and GSK. Carlos A Torres-Duque serves as advisor board member, speaker, consultant, and report grands and/or other fees from AstraZeneca Colombia, Boehringer-Ingelheim, Genzyme, GSK, Janssen Pharmaceuticals, MSD, Novartis y Sanofi. As research director from the Fundación Neumológica Colombiana has developed institutional activities with grants and/or other fees from AstraZeneca Colombia, Bayer, Boehringer-Ingelheim, Pfizer, Gilead Sciences, GSK, MSD, Novartis and Sanofi. Diana Rey serves as local advisor, consultant, speaker, and reports grands and/or other fees from Boehringer-Ingelheim, Novartis, Roche, AstraZeneca, Sanofi, GSK, and Amarey. Sergio Londoño, Stid Saenz, Maria Paula Avila, Elizabeth Mazo, Laura Botero are employees of Sanofi Colombia, and may hold shares and/or stock options in the company. All authors have no relationship with the tobacco industry.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2282668