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Cost-effectiveness of omalizumab in adults with severe asthma: results from the Asthma Policy Model.

AbstractBACKGROUND:
Omalizumab (trade name Xolair) is approved by the US Food and Drug Administration for treatment of moderate-to-severe allergic asthma. Given the high acquisition cost of omalizumab, its role and cost-effectiveness in disease management require definition.
OBJECTIVE:
We sought to identify the clinical and economic circumstances under which omalizumab might or might not be a cost-effective option by using a mathematic model.
METHODS:
We merged published data on clinical and economic outcomes (including acute event incidence, frequency/severity of hospitalizations, and health-related quality of life) to project 10-year costs, quality-adjusted life years (QALYs), and cost-effectiveness of treatment with omalizumab in addition to inhaled corticosteroids. Sensitivity analyses were conducted by using input data ranges from a variety of sources (published clinical trials and observational databases).
RESULTS:
For patients with baseline acute event rates, omalizumab conferred an additional 1.7 quality-adjusted months at an incremental cost of $131,000 over a 10-year planning horizon, implying a cost-effectiveness ratio of $821,000 per QALY gained. For patients with 5 times the baseline acute event rate, the cost-effectiveness ratio was $491,000 per QALY gained. The projected cost-effectiveness ratio could fall within a range of other programs that are widely considered to be cost-effective if the cost of omalizumab decreases to less than $200.
CONCLUSION:
Omalizumab is not cost-effective for most patients with severe asthma. The projected cost-effectiveness ratios could fall within a favorable range if the cost of omalizumab decreases significantly.
CLINICAL IMPLICATIONS:
Based on the high cost of omalizumab, it is especially important that clinicians explore alternative medications for asthma before initiating omalizumab.
AuthorsAnn C Wu, A David Paltiel, Karen M Kuntz, Scott T Weiss, Anne L Fuhlbrigge
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 120 Issue 5 Pg. 1146-52 (Nov 2007) ISSN: 1097-6825 [Electronic] United States
PMID17904628 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Anti-Allergic Agents
  • Antibodies, Anti-Idiotypic
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Omalizumab
Topics
  • Anti-Allergic Agents (economics, therapeutic use)
  • Antibodies, Anti-Idiotypic
  • Antibodies, Monoclonal (economics, therapeutic use)
  • Antibodies, Monoclonal, Humanized
  • Asthma (drug therapy, economics)
  • Cost-Benefit Analysis
  • Humans
  • Models, Theoretical
  • Omalizumab
  • Severity of Illness Index

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