Abstract

OBJECTIVE: To assess the cost-effectiveness of benralizumab (benra) vs mepolizumab (mepo) and dupilumab (dupi) for the treatment of patients with severe uncontrolled asthma from the Spanish Health System perspective.

METHODS: Exacerbations avoided, quality-adjusted life years (QALYs) gained and costs in a 5-year period were estimated with a Markov model, for a cohort of 1,000 patients in which, based on published evidence, 31% of the patients received biologics + oral corticosteroids (OCS) and 69% only biologics. Efficacy data (exacerbation reduction and OCS elimination) was derived from a matching-adjusted indirect comparison. Published EQ-5D utilities per health state (biologic alone, biologic + OCS, standard of care + OCS, exacerbations, and post-exacerbations) were used for QALYs estimation. Utility decrements associated with exacerbations management [-0.1 (OCS or emergency visits), -0.2 (hospitalization)] derived from literature were applied. Costs (€, 2021) included: drug acquisition (ex-factory price), administration and disease management. An expert panel (2 pneumologists and 1 pharmacist) validated all inputs.

RESULTS: Benra was more effective (54.03 QALYs) than mepo (53.22 QALYs) and dupi (53.13 QALYs). Benra avoided more exacerbations (2.87 exacerbations) compared to mepo (4.70 exacerbations) and dupi (5.11 exacerbations) for the 5-year horizon. Total costs/patient were €54,780.66 (benra), €57,605.60 (mepo) and €61,225.17 (dupi), resulting in benra dominating (more QALYs with lower costs) vs mepo and dupi.

CONCLUSIONS: Benralizumab can be considered a dominant treatment alternative vs other biologic drugs for the treatment of uncontrolled severe asthma patients in Spain.