Cost–effectiveness of bronchial thermoplasty in commercially-insured patients with poorly controlled, severe, persistent asthma

Abstract

Objectives: We examined the cost–effectiveness of treating poorly controlled, severe, persistent asthma patients with bronchial thermoplasty (BT), a novel technology that uses thermal energy to reduce airway smooth muscle mass, with 5-year outcome data demonstrating a durable reduction in asthma exacerbations. Study design: We conducted a model-based cost–effectiveness analysis assessing 5-year healthcare utilization, patient quality of life and adverse events. Methods: We utilized Markov modeling to estimate the costs and quality-of-life impact of BT compared with high-dose combination therapy among poorly controlled, severe, persistent asthma patients: those requiring high-dose combination therapy and having experienced an asthma exacerbation-related ER visit in the past year. Results: The cost–effectiveness of BT was US$5495 per quality-adjusted life year; and approximately 22% of sensitivity analysis iterations estimated BT to reduce costs and increase quality of life. Conclusions: BT is a cost–effective treatment option for patients with poorly controlled, severe, persistent asthma.

Keywords:

• asthma
• bronchial thermoplasty
• bronchoscopy
• cost–effectiveness
• respiratory disease

Financial & competing interests disclosure

This study was funded by Boston Scientific, Marlborough, MA, USA. MJ Cangelosi and KM Shriner are currently employed by Boston Scientific, which manufactures and markets Alair™ a device system for BT. JD Ortendahl, TGK Bentley and AM Anene are employees of PHAR, LLC, which was paid to conduct research described in this manuscript. LM Meckley was an employee of Boston Scientific at the time the analyses described in this manuscript were being conducted. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Poorly controlled, severe, persistent asthma negatively impacts quality-of-life and healthcare costs. The FDA-approved pharmacological treatments for asthma do not address excessive airway smooth muscle mass (ASM), an anatomical feature associated with increased asthma severity and morbidity in some patients.

• Bronchial thermoplasty (BT) is a novel bronchoscopic procedure that uses thermal energy to reduce ASM, resulting in a durable reduction in ASM and asthma exacerbations.

• This analysis estimates the cost–effectiveness of adding BT to standard care. The incremental cost–effectiveness ratio is US$5495, well below commonly cited willingness-to-pay thresholds [26].

• BT is a cost-effective treatment option for patients with poorly controlled, severe, persistent asthma.

Notes