Cost-effectiveness of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma

Abstract

Background: Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS) which worsen patients’ quality of life and increased healthcare spending. Objectives: To assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics but not optimally controlled with OMA. Methods: Uncontrolled patients referred to 6 asthma clinics in south of Italy switched from OMA to MEP, were enrolled and followed-up to Jan 2020. Clinical information included blood eosinophil count, asthma control test (ACT), pulmonary function, IgE, exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and exams. A 12-months standardized total cost per patient pre and post MEP was calculated in the perspective of Italian National Health System. Results: 33 patients were enrolled: 5 male, median age 59 years, disease onset 24 years. At OMA discontinuation, 89% were OCS-dependent with annual mean rate of 3.1 exacerbations. The switch to MEP reduced both exacerbation (-2.8) and OCS-dependent patients (-76%). Pulmonary function improved and both IgE, FENO and eosinophils serum decreased. Annual cost was €11,277 with OMA and €12,498 with MEP (p=0.2041), the increment due to biologic (+€1,673) was partially offset by the saving due to all other cost items (-€452). Conclusions: Patients with severe eosinophilic asthma not controlled by OMA experienced a clinically benefit in asthma control switching to MEP with a slight economic impact.