Lam Jenny, Hay Joel W, Salcedo Jonathan, Kenyon Nicholas J
a Department of Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy , University of Southern California , Los Angeles , CA , USA.
b Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California , Davis, Sacramento , CA , USA.
J Asthma. 2019 Aug;56(8):872-881. doi: 10.1080/02770903.2018.1500584. Epub 2018 Aug 29.
: Poorly controlled severe eosinophilic asthma is difficult and costly to manage. Reslizumab, an add-on treatment for adults with severe eosinophilic asthma, reduces the number of exacerbations and improves the quality of life (QoL). The objective of this study was to evaluate the cost-effectiveness of reslizumab. : A Markov model was used to compare the cost-effectiveness of add-on reslizumab with the standard-of-care (SOC) from the US societal perspective over a five-year time horizon. Efficacy and safety inputs for the model were based on data from two clinical trials (NCT01287039 and NCT01285323). Other model inputs, including mortality rates, costs, and utility, were estimated from literature, the Centers for Disease Control and Prevention (CDC), the US Department of Veterans Affairs (VA) and the Centers for Medicare and Medicaid Services (CMS). One-way, threshold, and probabilistic sensitivity analyses (PSA) were performed. Adherence, treatment response, and the placebo effect were evaluated in separate scenario analyses. : The base case incremental cost-effectiveness ratio (ICER) was $697 403 (2017 USD) per quality-adjusted life-years (QALYs). In the PSA, reslizumab becomes cost-effective in 50% of the iterations at a willingness-to-pay (WTP) threshold of $689 000. The model is most sensitive to the QoL improvement with reslizumab treatment in the one-way and threshold analyses. The response and adherence models had lower ICERs than the base model but still above $500 000. The ICER of the placebo effect model was $29 820. : The improvement in QoL and exacerbation rates with reslizumab are associated with high costs, making reslizumab unlikely to be cost-effective at the $200 000 WTP threshold.
控制不佳的重度嗜酸性粒细胞性哮喘难以管理且成本高昂。瑞利珠单抗作为成人重度嗜酸性粒细胞性哮喘的附加治疗药物，可减少病情加重次数并改善生活质量（QoL）。本研究的目的是评估瑞利珠单抗的成本效益。：采用马尔可夫模型从美国社会角度比较为期五年的附加瑞利珠单抗与标准治疗（SOC）的成本效益。该模型的疗效和安全性数据来自两项临床试验（NCT01287039和NCT01285323）。其他模型数据，包括死亡率、成本和效用，是根据文献、疾病控制与预防中心（CDC）、美国退伍军人事务部（VA）以及医疗保险和医疗补助服务中心（CMS）估算得出。进行了单因素、阈值和概率敏感性分析（PSA）。在单独的情景分析中评估了依从性、治疗反应和安慰剂效应。：基础病例增量成本效益比（ICER）为每质量调整生命年（QALY）697403美元（2017年美元）。在PSA中，在支付意愿（WTP）阈值为689000美元时，瑞利珠单抗在50%的迭代中具有成本效益。在单因素和阈值分析中，该模型对瑞利珠单抗治疗带来的QoL改善最为敏感。反应和依从性模型的ICER低于基础模型，但仍高于500000美元。安慰剂效应模型的ICER为29820美元。：瑞利珠单抗带来的QoL改善和病情加重率降低与高成本相关，这使得瑞利珠单抗在200000美元的WTP阈值下不太可能具有成本效益。
