OBJECTIVES: Bronchial thermoplasty (BT) is a technology that reduces airway smooth muscle mass and airway hyper-reactivity; studies have demonstrated a durable reduction in asthma exacerbations after BT treatment compared to standard of care. This analysis aimed to assess the projected cost–effectiveness of BT for asthma in Scotland.
METHODS: A Markov model was adapted comparing BT to standard care among poorly controlled, severe persistent asthma patients. Costs of BT, healthcare utilization, quality of life and maintenance medications were estimated from country- and clinic-specific pricing. Clinical efficacy and health utilities were estimated from the double-blind AIR2 trial and adjusted with clinic-data. The models assessed patients for 5 years; incremental cost-effectiveness ratios (ICERs) are reported.
RESULTS: We project the QALY improvement with BT was 0.1830. Incremental costs of BT were £4,460, driven primary by savings produced from averted future asthma exacerbations. Incremental cost-effectiveness ratios for BT compared to standard of care were £24,426/QALY 95% CI :(BT Dominant – £76,450/QALY). Sensitivity Analysis suggests a 58.3% likelihood of the ICER being less than £30,000/QALY. Results were most sensitive to utilities and time horizon.
CONCLUSIONS: Our findings are suggestive of projected cost-effectiveness of bronchial thermoplasty in severe, poorly-controlled asthma in Scotland. Real-world evidence of long term outcomes would help validate these results and further demonstrate cost-effectiveness.