Is bronchial thermoplasty cost‐effective as treatment for problematic asthma patients? Singapore's perspective on a global model

Abstract

Background and objective: Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a general framework for determining BT's cost-effectiveness in other healthcare settings. Methods: We developed a Markov model to estimate the costs and quality-adjusted life years (QALYs) gained with BT-OAT versus OAT from the societal and health system perspectives. The model was populated using Singapore-specific costs and transition probabilities and utilities from the literature. Sensitivity analyses were conducted to identify the main factors determining cost-effectiveness of BT-OAT. Results: BT-OAT is not cost-effective relative to OAT over a 5-year time horizon with an incremental costeffectiveness ratio (ICER) of $US138 889 per QALY from the societal perspective and $US139 041 per QALY from the health system perspective. The cost-effectiveness of BT-OAT largely depends on a combination of the cost of the BT procedure and the cost of asthma-related hospitalizations and emergency department (ED) visits. Conclusion: Based on established thresholds for costeffectiveness, BT-OAT is not cost-effective compared with OAT in Singapore. Given its current clinical efficacy, BT-OAT is most likely to be cost-effective in a setting where the cost of BT procedure is low and costs of hospitalization and ED visits are high.

Bronchial thermoplasty as a treatment for severe asthma: controversies, progress and uncertainties

“…For example, elevated total serum IgE levels, as well as biomarkers of type 2 inflammation [56], help select patients with severe allergic asthma suitable for anti-IgE therapy with omalizumab and a raised blood eosinophil count identifies patients suitable for therapy with monoclonal antibodies targeting IL-5 with subcutaneous mepolizumab [57], intravenous reslizumab [58] or subcutaneous benralizumab [59]. The GINA guideline considers bronchial thermoplasty as a potential treatment option at step 5 in some countries for selected adults with severe asthma whose asthma remains uncontrolled despite States, bronchial thermoplasty is estimated to be cost-effective in patients with severe uncontrolled asthma who have a high risk of exacerbations [63] or in patients with moderate to severe allergic asthma [64], whereas in Singapore, the procedure is not cost-effective compared to optimized usual care [65]. The likelihood of bronchial thermoplasty being a cost-effective treatment for severe asthma in a health care system are greater if the costs of hospitalization and emergency department are high and the costs of the procedure are low [65].…”

“…The GINA guideline considers bronchial thermoplasty as a potential treatment option at step 5 in some countries for selected adults with severe asthma whose asthma remains uncontrolled despite States, bronchial thermoplasty is estimated to be cost-effective in patients with severe uncontrolled asthma who have a high risk of exacerbations [63] or in patients with moderate to severe allergic asthma [64], whereas in Singapore, the procedure is not cost-effective compared to optimized usual care [65]. The likelihood of bronchial thermoplasty being a cost-effective treatment for severe asthma in a health care system are greater if the costs of hospitalization and emergency department are high and the costs of the procedure are low [65]. Other factors that influence the cost-effectiveness of bronchial thermoplasty are a patient's risk of a future exacerbation, the duration of follow-up after treatment and the health systems threshold in dollars for the willingness-to-pay per quality-adjusted life years (QALY).…”

Bronchial Thermoplasty: A New Therapeutic Option in Severe Uncontrolled Asthma

“…Zein and colleagues also concluded that BT is a cost effective intervention in patients with asthma at high risk of exacerbations [34]. However, a study carried out in Singapore found that BT is not cost effective compared with optimized asthma therapy unless the cost of the procedure is decreased so as to make it more cost effective [35].…”

Year in review 2017: Chronic obstructive pulmonary disease and asthma

“…According to longitudinal administrative data from Singapore, asthma control measured by the Asthma Control Test was associated with higher asthma drug costs, but significantly lower total asthma costs, especially for obese patients . However, in Singapore, the incremental cost‐effectiveness of bronchial thermoplasty combined with optimized asthma therapy was not found superior to optimized asthma therapy alone for difficult‐to‐treat and severe asthma patients …”

“…74 However, in Singapore, the incremental cost-effectiveness of bronchial thermoplasty combined with optimized asthma therapy was not found superior to optimized asthma therapy alone for difficult-to-treat and severe asthma patients. 75…”