Assessing the cost-effectiveness of mepolizumab as add-on therapy to standard of care for severe eosinophilic asthma in Singapore

Tan, Ling; Tan, Wan Hui Gloria; Aziz, Mohamed Ismail Abdul; Koh, Mariko Siyue; Tay, Tunn Ren; Pearce, Fiona; Ng, Kwong

doi:10.1080/02770903.2020.1837158

Cited by 15 publications

(3 citation statements)

References 42 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During the course of treatment, in addition to the positive clinical effects, we witnessed a rapid and stable depletion of blood eosinophils and MPO-ANCA, as well as an improvement in both pulmonary function tests and CT scan. Consequently, there was no need for initiating therapy with mepolizumab 300 mg every 4 weeks, probably more effective than the lower dose but also burdened with much higher pharmacoeconomic costs, already high at the 100 mg dose [50]. The present study shows that benralizumab was effective in obtaining a great improvement in our patient outcomes, with positive results just after a few weeks, that were mainteined after a year, thanks to its "aggressive" effect of tissue depletion of eosinophils.…”

Section: Discussionmentioning

confidence: 50%

Successful treatment with benralizumab in a patient with eosinophilic granulomatosis with polyangiitis refractory to mepolizumab

et al. 2021

View full text Add to dashboard Cite

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by necrotizing eosinophilic granulomatous inflammation that frequently involves the respiratory tract (90% of cases). Asthma in EGPA is systematically severe and often refractory to common treatment, it is corticosteroid resistant and can often anticipate the onset of systemic vasculitis by many years. A release of cytokines necessary for the activation, maturation and survival of eosinophils, such as IL-4, IL-5 and IL-13 occurs in the activated Th-2 phenotype. In particular, IL-5 level is high in active EGPA and its inhibition has become a key therapeutic target. Oral glucocorticoids (OCS) are effective treatment options but unfortunately, frequent relapses occur in many patients and they lead to frequent side effects. As for now, there are currently no official recommendations on doses and treatment schedules in the management of EGPA.Case presentation: In this article, we describe the case of a man with EGPA, severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), with poor asthma and CRSwNP control despite OCS and mepolizumab treatment. Respiratory and vasculitis symptoms improved markedly after therapeutic switch to benralizumab. During the treatment, in addition to clinical effects, we witnessed a depletion of blood eosinophils, as well as an improvement in both pulmonary function tests, CT scan and skin lesions present initially. Conclusions: While there are many studies confirming the efficacy of benralizumab in EGPA, the most interesting aspect of our report is that efficacy was confirmed in a patient previously unresponsive to mepolizumab, known to be effective in EGPA.

show abstract

Section: Discussionmentioning

confidence: 50%

Successful treatment with benralizumab in a patient with eosinophilic granulomatosis with polyangiitis refractory to mepolizumab

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Despite limiting the use of mepolizumab to patients with frequent exacerbations at baseline (3 in the past year) in a scenario analysis, the ICER remained high (USD 1,198 per QALY earned). Consequently, at its current price, mepolizumab was not considered cost-effective except on the condition of significant price reductions [ 65 ]. In a recent Swedish analysis, benralizumab demonstrated cost-effectiveness compared to usual care plus OCS with USD 4,404 per QALY gained, based on increases of 1.33 QALY and USD 5,868 per patient.…”

Section: Pharmacological Optionsmentioning

confidence: 99%

The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review

et al. 2021

View full text Add to dashboard Cite

Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.

show abstract

“…Biologics are expensive, costing roughly $10,000 to $30,000 USD per person-year (22). Consequently, a considerable proportion of eligible patients lack adequate access to biologics, such as in Singapore where the cost-effectiveness pro le is currently beyond the accepted willingness-to-pay threshold for formulary approval (23). The e ciency and costeffectiveness of biologic therapy could potentially be improved using a 'precision medicine' approach to therapy, i.e., basing treatment choices on predicted response given each patient's unique characteristics (24).…”

Section: Introductionmentioning

confidence: 99%

Can we predict who will benefit most from biologics in severe asthma? A post-hoc analysis of two phase 3 trials

Chen

Reddel

FitzGerald

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Individualized prediction of treatment response may improve the value proposition of advanced treatment options in severe asthma. This study aimed to investigate the combined capacity of patient characteristics in predicting treatment response to mepolizumab in patients with severe asthma. Methods: Patient-level data were pooled from two multinational phase 3 trials of mepolizumab in severe eosinophilic asthma. We fitted penalized regression models to quantify reductions in the rate of severe exacerbations and the 5-item Asthma Control Questionnaire (ACQ5) score. The capacity of 15 covariates towards predicting treatment response was quantified by the Gini index (measuring disparities in treatment benefit) as well as observed treatment benefit within the quintiles of predicted treatment benefit. Results: There was marked variability in the ability of patient characteristics to predict treatment response; covariates explained greater heterogeneity in predicting treatment response to asthma control than to exacerbation frequency (Gini index 0.35 v. 0.24). Overall, the average reduction in exacerbations was 0.90/year (95%CI, 0.87‒0.92) and average reduction in ACQ5 score was 0.18 (95% CI, 0.02‒0.35). Among the top 20% of patients for predicted treatment benefit, exacerbations were reduced by 2.23/year (95% CI, 2.03‒2.43) and ACQ5 score were reduced by 0.59 (95% CI, 0.19‒0.98). Among the bottom 20% of patients for predicted treatment benefit, exacerbations were reduced by 0.25/year (95% CI, 0.16‒0.34) and ACQ5 by -0.20 (95% CI, -0.51 to 0.11).Conclusion: A precision medicine approach based on multiple patient characteristics can guide biologic therapy in severe asthma, especially in identifying patients who will not benefit as much from therapy. Patient characteristics had a greater capacity to predict treatment response to asthma control than exacerbation.Trial registration: ClinicalTrials.gov number, NCT01691521 (registered September 24, 2012) and NCT01000506 (registered October 23, 2009).

show abstract

Assessing the cost-effectiveness of mepolizumab as add-on therapy to standard of care for severe eosinophilic asthma in Singapore

Cited by 15 publications

References 42 publications

Successful treatment with benralizumab in a patient with eosinophilic granulomatosis with polyangiitis refractory to mepolizumab

Successful treatment with benralizumab in a patient with eosinophilic granulomatosis with polyangiitis refractory to mepolizumab

The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review

Can we predict who will benefit most from biologics in severe asthma? A post-hoc analysis of two phase 3 trials

Contact Info

Product

Resources

About