Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma
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{"title"=>"Cost-effectiveness of bronchial thermoplasty, omalizumab, and standard therapy for moderate-to-severe allergic asthma", "type"=>"journal", "authors"=>[{"first_name"=>"Zafar", "last_name"=>"Zafari", "scopus_author_id"=>"43661980900"}, {"first_name"=>"Mohsen", "last_name"=>"Sadatsafavi", "scopus_author_id"=>"21733729500"}, {"first_name"=>"Carlo A.", "last_name"=>"Marra", "scopus_author_id"=>"7102675590"}, {"first_name"=>"Wenjia", "last_name"=>"Chen", "scopus_author_id"=>"55794111000"}, {"first_name"=>"J. Mark", "last_name"=>"FitzGerald", "scopus_author_id"=>"56414027200"}], "year"=>2016, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"26751790", "sgr"=>"84954487181", "doi"=>"10.1371/journal.pone.0146003", "scopus"=>"2-s2.0-84954487181", "pui"=>"607726691", "issn"=>"19326203"}, "id"=>"0d6b29c6-2d50-3044-83d7-c0fd878c708c", "abstract"=>"BACKGROUND: Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.\\n\\nOBJECTIVE: To evaluate the cost-effectiveness of standard therapy, BT, and omalizumab for moderate-to-severe allergic asthma in the USA.\\n\\nMETHODS: A probabilistic Markov model with weekly cycles was developed to reflect the course of asthma progression over a 5-year time horizon. The study population was adults with moderate-to-severe allergic asthma whose asthma remained uncontrolled despite using high-dose inhaled corticosteroids (ICS, with or without long-acting beta-agonists [LABA]). A perspective of the health-care system was adopted with asthma-related costs as well as quality-adjusted life years (QALYs) and exacerbations as the outcomes.\\n\\nRESULTS: For standard therapy, BT, and omalizumab, the discounted 5-year costs and QALYs were $15,400 and 3.08, $28,100 and 3.24, and $117,000 and 3.26, respectively. The incremental cost-effectiveness ratio (ICER) of BT versus standard therapy and omalizumab versus BT was $78,700/QALY and $3.86 million/QALY, respectively. At the willingness-to-pay (WTP) of $50,000/QALY and $100,000/QALY, the probability of BT being cost-effective was 9%, and 67%, respectively. The corresponding expected value of perfect information (EVPI) was $155 and $1,530 per individual at these thresholds. In sensitivity analyses, increasing the costs of BT from $14,900 to $30,000 increased its ICER relative to standard therapy to $178,000/QALY, and decreased the ICER of omalizumab relative to BT to $3.06 million/QALY. Reducing the costs of omalizumab by 25% decreased its ICER relative to BT by 29%.\\n\\nCONCLUSIONS: Based on the available evidence, our study suggests that there is more than 60% chance that BT becomes cost-effective relative to omalizumab and standard therapy at the WTP of $100,000/QALY in patients with moderate-to-severe allergic asthma. However, there is a substantial uncertainty in the underlying evidence, indicating the need for future research towards reducing such uncertainty.", "link"=>"http://www.mendeley.com/research/costeffectiveness-bronchial-thermoplasty-omalizumab-standard-therapy-moderatetosevere-allergic-asthm", "reader_count"=>29, "reader_count_by_academic_status"=>{"Librarian"=>2, "Student > Doctoral Student"=>4, "Researcher"=>3, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>10, "Other"=>4, "Professor"=>2, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Librarian"=>2, "Student > Doctoral Student"=>4, "Researcher"=>3, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>10, "Other"=>4, "Professor"=>2, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>1, "Engineering"=>1, "Biochemistry, Genetics and Molecular Biology"=>1, "Nursing and Health Professions"=>5, "Medicine and Dentistry"=>15, "Philosophy"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>3, "Social Sciences"=>2}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>15}, "Social Sciences"=>{"Social Sciences"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>5}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>3}, "Philosophy"=>{"Philosophy"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "United States"=>1}, "group_count"=>3}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2625041"], "description"=>"<p>Health states include: exacerbation-free, exacerbation states: exacerbation requiring oral corticosteroids, emergency room visit, hospitalizations, and death state.</p>", "links"=>[], "tags"=>["omalizumab", "sensitivity analyses", "bt", "study population", "wtp", "therapy", "Bronchial Thermoplasty", "LABA", "evpi", "asthma progression", "icer", "Standard Therapy", "alternative treatments", "Markov model", "qaly", "future research", "life years", "ics"], "article_id"=>1635873, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Zafar Zafari", "Mohsen Sadatsafavi", "Carlo A. Marra", "Wenjia Chen", "J. Mark FitzGerald"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0146003.g001", "stats"=>{"downloads"=>1, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Schematic_Markov_states_/1635873", "title"=>"Schematic Markov states.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2016-01-18 15:13:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/2625042"], "description"=>"<p>(A) Cost-effectiveness plane; (B) Cost-effectiveness acceptability curve; and (C) Expected value of information.</p>", "links"=>[], "tags"=>["omalizumab", "sensitivity analyses", "bt", "study population", "wtp", "therapy", "Bronchial Thermoplasty", "LABA", "evpi", "asthma progression", "icer", "Standard Therapy", "alternative treatments", "Markov model", "qaly", "future research", "life years", "ics"], "article_id"=>1635874, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Zafar Zafari", "Mohsen Sadatsafavi", "Carlo A. Marra", "Wenjia Chen", "J. Mark FitzGerald"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0146003.g002", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_A_Cost_effectiveness_plane_B_Cost_effectiveness_acceptability_curve_and_C_Expected_value_of_information_/1635874", "title"=>"(A) Cost-effectiveness plane; (B) Cost-effectiveness acceptability curve; and (C) Expected value of information.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2016-01-18 15:13:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/2625044"], "description"=>"<p>One-way sensitivity analysis: (A) BT versus standard therapy, (B) omalizumab versus BT.</p>", "links"=>[], "tags"=>["omalizumab", "sensitivity analyses", "bt", "study population", "wtp", "therapy", "Bronchial Thermoplasty", "LABA", "evpi", "asthma progression", "icer", "Standard Therapy", "alternative treatments", "Markov model", "qaly", "future research", "life years", "ics"], "article_id"=>1635876, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Zafar Zafari", "Mohsen Sadatsafavi", "Carlo A. Marra", "Wenjia Chen", "J. Mark FitzGerald"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0146003.g003", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_One_way_sensitivity_analysis_A_BT_versus_standard_therapy_B_omalizumab_versus_BT_/1635876", "title"=>"One-way sensitivity analysis: (A) BT versus standard therapy, (B) omalizumab versus BT.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2016-01-18 15:13:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/2625045"], "description"=>"<p>Incremental cost-effectiveness ratio as a function of BT’s cost: (A) BT versus standard therapy, (B) omalizumab versus BT.</p>", "links"=>[], "tags"=>["omalizumab", "sensitivity analyses", "bt", "study population", "wtp", "therapy", "Bronchial Thermoplasty", "LABA", "evpi", "asthma progression", "icer", "Standard Therapy", "alternative treatments", "Markov model", "qaly", "future research", "life years", "ics"], "article_id"=>1635877, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Zafar Zafari", "Mohsen Sadatsafavi", "Carlo A. Marra", "Wenjia Chen", "J. Mark FitzGerald"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0146003.g004", "stats"=>{"downloads"=>2, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_analysis_for_the_costs_of_BT_/1635877", "title"=>"Sensitivity analysis for the costs of BT.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2016-01-18 15:13:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/2625046"], "description"=>"<div><p>Background</p><p>Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.</p><p>Objective</p><p>To evaluate the cost-effectiveness of standard therapy, BT, and omalizumab for moderate-to-severe allergic asthma in the USA.</p><p>Methods</p><p>A probabilistic Markov model with weekly cycles was developed to reflect the course of asthma progression over a 5-year time horizon. The study population was adults with moderate-to-severe allergic asthma whose asthma remained uncontrolled despite using high-dose inhaled corticosteroids (ICS, with or without long-acting beta-agonists [LABA]). A perspective of the health-care system was adopted with asthma-related costs as well as quality-adjusted life years (QALYs) and exacerbations as the outcomes.</p><p>Results</p><p>For standard therapy, BT, and omalizumab, the discounted 5-year costs and QALYs were $15,400 and 3.08, $28,100 and 3.24, and $117,000 and 3.26, respectively. The incremental cost-effectiveness ratio (ICER) of BT versus standard therapy and omalizumab versus BT was $78,700/QALY and $3.86 million/QALY, respectively. At the willingness-to-pay (WTP) of $50,000/QALY and $100,000/QALY, the probability of BT being cost-effective was 9%, and 67%, respectively. The corresponding expected value of perfect information (EVPI) was $155 and $1,530 per individual at these thresholds. In sensitivity analyses, increasing the costs of BT from $14,900 to $30,000 increased its ICER relative to standard therapy to $178,000/QALY, and decreased the ICER of omalizumab relative to BT to $3.06 million/QALY. Reducing the costs of omalizumab by 25% decreased its ICER relative to BT by 29%.</p><p>Conclusions</p><p>Based on the available evidence, our study suggests that there is more than 60% chance that BT becomes cost-effective relative to omalizumab and standard therapy at the WTP of $100,000/QALY in patients with moderate-to-severe allergic asthma. However, there is a substantial uncertainty in the underlying evidence, indicating the need for future research towards reducing such uncertainty.</p></div>", "links"=>[], "tags"=>["omalizumab", "sensitivity analyses", "bt", "study population", "wtp", "therapy", "Bronchial Thermoplasty", "LABA", "evpi", "asthma progression", "icer", "Standard Therapy", "alternative treatments", "Markov model", "qaly", "future research", "life years", "ics"], "article_id"=>1635878, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Zafar Zafari", "Mohsen Sadatsafavi", "Carlo A. Marra", "Wenjia Chen", "J. Mark FitzGerald"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0146003", "stats"=>{"downloads"=>2, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_Effectiveness_of_Bronchial_Thermoplasty_Omalizumab_and_Standard_Therapy_for_Moderate_to_Severe_Allergic_Asthma_/1635878", "title"=>"Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2016-01-18 15:13:15"}

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Relative Metric

{"start_date"=>"2016-01-01T00:00:00Z", "end_date"=>"2016-12-31T00:00:00Z", "subject_areas"=>[]}
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