Zafari Zafar, Sadatsafavi Mohsen, Mark FitzGerald J
1Mailman School of Public Health, Columbia University, New York, USA.
2Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Cost Eff Resour Alloc. 2018 Jan 30;16:3. doi: 10.1186/s12962-018-0089-8. eCollection 2018.
A significant minority of asthma patients remain uncontrolled despite the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). A number of add-on therapies, including monoclonal antibodies (namely omalizumab) and more recently tiotropium bromide have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of tiotropium versus omalizumab as add-on therapies to ICS + LABA for patients with uncontrolled allergic asthma.
A probabilistic Markov model of asthma was created. Total costs (in 2013 US $) and health outcomes of three interventions including standard therapy (ICS + LABA), add-on therapy with tiotropium, and add-on therapy with omalizumab, were calculated over a 10-year time horizon. Future costs and quality-adjusted life years (QALYs) were discounted at the rate of 3%. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at willingness-to-pay value of $50,000.
The 10-year discounted costs and QALYs for standard therapy were $38,432 and 6.79, respectively. The corresponding values for add-on therapy with tiotropium and with omalizumab were $41,535 and 6.88, and $217,847 and 7.17, respectively. The incremental cost-effectiveness ratios (ICER) of add-on therapy with tiotropium versus standard therapy, and omalizumab versus tiotropium were $34,478/QALY, and $593,643/QALY, respectively. The model outcomes were most sensitive to the costs of omalizumab but were robust against other assumptions.
Although omalizumab had the best health outcomes, add-on therapy with tiotropium was a cost-effective alternative to omalizumab and standard therapy for uncontrolled allergic asthma at willingness-to-pay of $50,000/QALY.
尽管使用了吸入性糖皮质激素（ICS）和长效β受体激动剂（LABA），仍有相当一部分哮喘患者病情未得到控制。对于这部分患者，已推荐了多种附加疗法，包括单克隆抗体（如奥马珠单抗）以及最近的噻托溴铵。本研究的目的是评估噻托溴铵与奥马珠单抗作为ICS + LABA附加疗法用于控制不佳的过敏性哮喘患者的成本效益。
建立了一个哮喘的概率性马尔可夫模型。在10年的时间范围内计算了三种干预措施的总成本（以2013年美元计）和健康结局，这三种干预措施包括标准疗法（ICS + LABA）、噻托溴铵附加疗法和奥马珠单抗附加疗法。未来成本和质量调整生命年（QALY）以3%的贴现率进行贴现。进行了多项敏感性分析。在支付意愿值为50,000美元时评估成本效益。
标准疗法的10年贴现成本和QALY分别为38,432美元和6.79。噻托溴铵附加疗法和奥马珠单抗附加疗法的相应值分别为41,535美元和6.88，以及217,847美元和7.17。噻托溴铵附加疗法与标准疗法以及奥马珠单抗与噻托溴铵的增量成本效益比（ICER）分别为34,478美元/QALY和593,643美元/QALY。模型结果对奥马珠单抗的成本最为敏感，但对其他假设具有稳健性。
尽管奥马珠单抗具有最佳的健康结局，但在支付意愿为50,000美元/QALY时，噻托溴铵附加疗法对于控制不佳的过敏性哮喘而言是一种相对于奥马珠单抗和标准疗法具有成本效益的替代方案。
