Cost-effectiveness analysis of anti–IL-5 therapies of severe eosinophilic asthma in Spain

Figures & data

Figure 1. Markov model. OCS, oral corticosteroid; ED, emergency department. All-cause mortality not shown for simplification purposes of the figure. All health states are associated with general population mortality.

Table 1. Clinical data.

	Subgroup  ≥ 300 cells/µL	Subgroup  ≥ 400 cells/µL	Source
Clinically significant exacerbation rate
Mepolizumab + SoC
All patients	0.37 (0.35)	0.32 (0.41)	MENSA
mCC	0.26 (0.51)	0.16 (0.71)	MENSA
Standard of Care
All patients	1.43 (0.20)	1.64 (0.20)	MENSA
Patients with ≥ 50% exacerbation reduction	78.3%	78.2%	MENSA
Network meta-analysis: relative effects
Mepolizumab + SoC RR
All patients	0.036 (0.27–0.49)	0.028 (0.19–0.4)	NMA
Benralizumab + SoC RR
All patients	0.59 (0.41–0.86)	0.50 (0.39–0.65)	NMA
mCC	0.41 (0.29–0.60)	0.25 (0.20–0.33)	Adjusted by the same factor detected on MEP all patients/meeting CC
Reslizumab RR
All patients	—	0.50 (0.4–0.62)	NMA
mCC	—	0.25 (0.20–0.31)	Adjusted by the same factor detected on MEP all patients/meeting CC
Distribution over type of exacerbation
Exacerbation: OCS burst	83.2%	83.2%	MENSA
Exacerbation: ED visit	6.1%	6.0%	MENSA
Exacerbation: Hospitalization	10.6%	10.7%	MENSA

Abbreviations. ED: emergency department; mCC, meeting continuation criteria; MEP: mepolizumab; NMA: Network Meta-analysis: OCS: oral corticosteroids; RR: Risk Ratio; SoC: Standard of Care.

Table 2. Costs of drugs, monitoring, exacerbations, and adverse events.

Costs
Intervention, drug costs
Mepolizumab	€1,086.00	Botplus^39
Benralizumab	€2,172.00	Botplus^39
Reslizumab	€1,274.68
Standard of Care
Biologics	€35.86/cycle	Botplus (pooled: ICS, LABA, SABA, Anti-leukotriene, Theophyllines and predinosolone)^39
SoC	€35.93/cycle	Botplus (pooled: ICS, LABA, SABA, Anti-leukotriene, Theophyllines and predinosolone)^39
Monitoring treatment (average cost)
Mepolizumab	€7.19/cycle	e-salud 2019 (1 physician visit and 12 nurse visits, annually)^41
Benralizumab
Year 1	€9.56/cycle	e-salud 2019 (1 physician visit and 6 nurse visits, annually)^41
Year 1+	€9.95/cycle
Reslizumab	€7.19/cycle	e-salud 2019 (1 physician visit and 5.5 nurse visits, annually)^41
SoC	€13.40/cycle	e-salud 2019 (1 physician visit and 12 nurse visits, annually)^41
Exacerbations
OCS burst	€50.49/event	Bot-plus^39 and e-salud 2019^41
ED visit	€218.65/event	Bot-plus^39 and e-salud 2019^41
Hospitalization	€3,975.28/event	Bot-plus^39 and e-salud 2019^41
Adverse Events
Cataract	€2,334.09	GRD-APR 70 (Ministerio de Sanidad, n.d.)^40
Acute myocardial infarction	€5,496.75	GRD-APR 190 (Ministerio de Sanidad, n.d.)^40
Gastroduodenal ulcer	€5,578.97	GRD-APR 241 (Ministerio de Sanidad, n.d.)^40
Osteoporosis	€6.40	Botplus^39
Diabetes (without complications)	€4,108.42	Crespo et al.^42

Table 3. Utility values.

Parameters	Value		Source
Health state Utilities	Subgroup  ≥ 300 cells/µL	Subgroup  ≥ 400 cells/µL
Mepolizumab (all)	0.777	0.775	MENSA^33^,^50
Mepolizumab (mCC)	0.790	0.783	MENSA Adjusted by the patients with ≥ 50% exacerbation reduction
Benralizumab (all)	0.754	—	MUSCA^51
Benralizumab (mCC)	0.767	—	MUSCA^51
Reslizumab (all)	—	0.753	MUSCA^51
Reslizumab (mCC)	—	0.761	MUSCA^51
SoC	0.671	0.661	MENSA^33^,^50
Exacerbations
Disutilities
OCS burst	−0.100 (12.68 days)	Lloyd^52 utilities and MENSA days
ED visit	−0.100 (10.41 days)	Assume equal utility of OCs burst in Lloyd^52 and MENSA days
Hospitalization	−0.200 (20.70 days)	Lloyd^52 utilities and MENSA days
Adverse events, disutility values
Cataract	–0.0271	Sullivan 2011^53
Acute myocardial infarction	–0.0557	Sullivan 2011^53
Gastroduodenal ulcer	–0.0552	Sullivan 2011^53
Osteoporosis	–0.0418	Sullivan 2011^53
Diabetes (without complications)	–0.0621	Sullivan 2011^53

Abbreviations. mCC, meeting continuation criteria; SoC, Standard of Care; OCS, Oral Corticosteroids; ED, Emergency Department.

Table 4. Results of the cost-effectiveness analysis at 5 years.

	Subgroup ≥ 300 cells/µL		Subgroup ≥ 400 cells/µL
EFFECTIVENESS	MEP	BEN	MEP	RES
Asthma related mortality	0.92%	1.10%	0.95%	1.19%
OCS, n exacerbations	2.66	3.19	2.71	3.42
ED, n exacerbations	0.20	0.24	0.20	0.25
Hospitalization, n exacerbations	0.34	0.41	0.35	0.44
Life years	4.596	4.591	4.596	4.590
QALYs	3.406	3.330	3.373	3.298
COST (€)
Total costs	47,706.59	50,880.06	47,739.84	55,512.79
Intervention costs	42,886	45,842	42,874	50,241
Monitoring treatment costs	367	282	367	367
SoC costs	2,147	2,145	2,147	2,144
Exacerbation: OCS burst	134	161	137	172
Exacerbation: ED visit	43	51	43	54
Exacerbation: Hospitalization	1,348	1,617	1,390	1,752
OCS related AE costs	782	782	782	782
INCREMENTALS
Costs	–€3,173.47	–€7,772.95
QALYs	0.076	0.075
Incremental cost-effectiveness	Dominant	Dominant

Abbreviations. QALYs, Quality Adjusted life-years; OCS, Oral Corticosteroids; ED, Emergency Department.

Figure 2. Cost-effectiveness plane.

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