To determine the optimal strategy from the economic point of view of treatment of uncontrolled bronchial asthma, scientists from several clinical centers of the Russian Federation conducted detailed pharmacoeconomic analysis. His results were published in the journal "Practical Pulmonology" (No. 4, 2015).
The authors compared two strategies of therapy:
1) standard therapy, which was understood as follows: 100% of patients received long-acting β2-agonists + inhaled glucocorticosteroids (1775 μg budesonide or 1150 μg fluticasone); 35% of patients received leukotriene receptor antagonists (montelukast 10 mg per day); 100% - system glucocorticosteroids (prednisolone tablets 13 mg per day).
2) standard therapy + omalizumab (monoclonal antibody to IgE, see the figure below).
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The study included patients who had undergone 4 hospitalizations for a year or more, receiving oral glucocorticosteroids, which requires an average of 300 mg of omalizumab per month (150 to 600 mg per month). The cost of each treatment strategy of the patient of the target group was estimated, the total costs for the application of the compared strategies were calculated. The criterion for the effectiveness of the model was utility (quality of life), as well as the frequency of severe exacerbations. Two time horizons of modeling are considered - 2 and 5 years. As a result, the greatest total costs were noted with the use of the omalizumab strategy: at the modeling horizon of 2 years (Figure 2a) - 1 033 020 rub. (only standard therapy - 787 729 rubles.), 5 years - 2 344 411 rubles. (only standard therapy is 1,836,143 rubles (Figure 2b) However, as can be seen in Figure 2, the strategy with omalizumab requires 44% less costs, including losses of GDP, social insurance funds and direct medical services, including on alleviating the symptoms of bronchial asthma.
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In addition, the strategy of treatment with omalizumab under the simulation conditions prevented 3.6 cases of severe exacerbation with hospitalization in one patient for 2 years and 8.9 cases for 5 years; decreased patient mortality by 0.34 and 0.91%, respectively; reduced the number of patients with a lack of control over bronchial asthma at 22.5 and 21.7%, respectively.So, when considering such an additional efficiency criterion, such as reducing the number of hospitalizations for the year, additional costs for one reduced hospitalization (ICER) amounted to an additional 68,106.81 rubles. for the prevention of one hospitalization per year at a 2-year modeling horizon and 57,286.81 rubles. at the 5-year horizon of modeling. These figures did not exceed the so-called "threshold of society's willingness to pay," according to the analysis of sensitivity.
The authors cite the following conclusions:
1. C pharmacoeconomic positions, using a cost-benefit analysis, it was found that the strategy omalizumab plus standard therapy is economically feasible in patients 18 years and older with an increased incidence of hospitalizations (4 per year and more) that require the administration of oral glucocorticosteroids when omalizumab is administered at a dose of 300 mg per month.
2. Analysis of the impact on the budget did not reveal a significant burden. In case if within 2 years omalizumab in an average dose of 300 mg per month (150 to 600 mg per month), 6.8-7.1% of patients with severe uncontrolled bronchial asthma, with 4 or more hospital admissions per year,taking systemic glucocorticosteroids, then for the treatment of 100 patients additional funds will be needed, which, under other conditions, can be treated with standard therapy without omalizumab in 2 adult patients.
3. When analyzing the cost-effectiveness of reducing the frequency of hospitalizations, it was found that to prevent one hospitalization it is necessary to spend an additional 68,106.81 rubles. at a 2-year simulation horizon and 57,286.81 rubles. at a 5-year modeling horizon in adult patients receiving an average of 300 mg of omalizumab per month.