Cost-effectiveness of tiotropium versus omalizumab for uncontrolled allergic asthma in US
- Cost-effectiveness of tiotropium versus omalizumab for uncontrolled allergic asthma in US
- Zafari, Zafar
Mark FitzGerald, J.
Canadian Respiratory Research Network
- Mailman School of Public Health
- Persistent URL:
- Book/Journal Title:
- Cost Effectiveness and Resource Allocation
- Geographic Area:
- United States
- Tiotropium, Omalizumab, Uncontrolled asthma, Cost-effectiveness analysis, Decision analysis, Markov model
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.
- Drugs--Cost effectiveness
Markov processes--Mathematical models
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- Suggested Citation:
- Zafar Zafari, Mohsen Sadatsafavi, J. Mark FitzGerald, Canadian Respiratory Research Network, 2018, Cost-effectiveness of tiotropium versus omalizumab for uncontrolled allergic asthma in US, Columbia University Academic Commons, https://doi.org/10.7916/D8TB2KG0.