Cost-utility analysis of dupilumab add on therapy versus standard therapy in adolescents and adults for severe asthma in Colombia

ABSTRACT

Introduction

Dupilumab is a recombinant human IgG4 monoclonal antibody that inhibits IL-4 and IL-13 signaling. This drug raises concerns about the economic impact in scenarios with constrained resources. This study aimed to estimate the cost-utility of dupilumab plus standard care (SoC) vs SoC alone in adolescents and adults with severe asthma and eosinophilic phenotype.

Methods

A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with uncontrolled allergic asthma in Colombia. Total costs and QALYs of standard therapy (ICS + LABA), add-on therapy with dupilumab, were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of $19,000.

Results

The base-case analysis showed dupilumab was associated with higher annual annual per-patient costs (US$5,719 for dupilumab and US$1,214 for standard therapy) and higher QALYs than standard therapy (fe  4.06 QALYs vs 3.97 QALYs, respectively). . The incremental cost–effectiveness ratio estimated was US$50,160 per QALY gained

Conclusion

Dupilumab is not cost-effective using a WTP of US$19000 per QALY threshold in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

KEYWORDS:

• Health economics
• public health
• healthcare

Funding

This paper was not funded.

List of abbreviations

quality-adjusted life-years (QALYs)

Forced expiratory volume in the first second (FEV1)

flows expiratory peak (FEP) Standard care (SoC)

Oral corticosteroids (OCS)

Inhaled corticosteroids plus long-acting β₂-agonists (ICS plus LABA)

willingness-to-pay (WTP)

Consolidated Health Economic Evaluation Reporting Standards (CHEERS)

exhaled nitric oxide test (FeNO)

blood eosinophil (EOS)

Author contributions

J Buendía and D Patiño contributed equally in: conceived and designed the analysis, collected the data, performed the analysis and writing the paper.

Acknowledgments

None

Ethics approval

This study was approved by the Institutional Review Board of University of Antioquia (2015-4690)

Availability of Data and Materials: jefferson buendia. (2021). BD CU Dupilumab [Data set]. Zenodo. http://doi.org/10.5281/zenodo.4700232

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.