Tan Ling Eng, Tan Wan Hui Gloria, Aziz Mohamed Ismail Abdul, Koh Mariko Siyue, Tay Tunn Ren, Pearce Fiona, Ng Kwong
Ministry of Health, Agency for Care Effectiveness, Singapore, Singapore.
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
J Asthma. 2022 Jan;59(1):189-199. doi: 10.1080/02770903.2020.1837158. Epub 2020 Nov 10.
To evaluate the cost-effectiveness of mepolizumab added to standard of care (SOC) compared with SOC alone among patients with severe uncontrolled eosinophilic asthma in the Singapore setting.
A Markov model with three health states (asthma on mepolizumab and SOC, asthma on SOC alone, and death) was developed from a healthcare system perspective over a lifetime horizon. During each 4-week cycle, patients in the non-death health states could experience asthma exacerbations requiring oral corticosteroid burst, emergency department visit, or hospitalization. Asthma-related mortality following an exacerbation or all-cause mortality could also occur at each cycle. The model was populated using local costs while utilities were derived from international literature. Transition probabilities were obtained from a mixture of Singapore-specific and internationally published data.
The base-case analysis comparing mepolizumab plus SOC with SOC alone resulted in an incremental cost-effectiveness ratio (ICER) of SGD335 486 (USD238 195) per quality-adjusted life-year (QALY) gained. Sensitivity analysis demonstrated that the ICER was most sensitive to the price of mepolizumab, followed by the proportion of exacerbations which required hospital intensive care. Despite restricting mepolizumab use to patients with a higher baseline exacerbation rate (3 in the past year) in a scenario analysis, the ICER remained high at SGD238 876 (USD 169 602) per QALY gained.
At its current price, mepolizumab is not considered a cost-effective use of healthcare resources in Singapore. Substantial price reductions for mepolizumab are required to improve its cost-effectiveness to an acceptable range. These results will be useful to inform national funding decisions.
在新加坡背景下，评估在标准治疗（SOC）基础上加用美泊利珠单抗与单纯使用SOC相比，在重度未控制嗜酸性粒细胞性哮喘患者中的成本效益。
从医疗保健系统角度出发，建立了一个具有三种健康状态（使用美泊利珠单抗和SOC治疗的哮喘、单纯使用SOC治疗的哮喘以及死亡）的马尔可夫模型，模型周期为终身。在每个4周周期内，非死亡健康状态的患者可能会经历需要口服糖皮质激素冲击治疗、急诊就诊或住院治疗的哮喘急性发作。在每个周期也可能发生急性发作后的哮喘相关死亡率或全因死亡率。模型使用当地成本数据，效用值则来源于国际文献。转移概率从新加坡特定数据和国际发表的数据混合中获取。
将美泊利珠单抗加SOC与单纯SOC进行的基础病例分析显示，每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）为335486新元（238195美元）。敏感性分析表明，ICER对美泊利珠单抗的价格最为敏感，其次是需要医院重症监护的急性发作比例。在一项情景分析中，尽管将美泊利珠单抗的使用限制在基线急性发作率较高（过去一年中发作3次）的患者中，但每获得一个QALY的ICER仍高达238876新元（169602美元）。
以目前的价格，美泊利珠单抗在新加坡不被认为是一种具有成本效益的医疗资源使用方式。需要大幅降低美泊利珠单抗的价格，以将其成本效益提高到可接受范围。这些结果将有助于为国家资金决策提供参考。
