PRS29 - An Evaluation of the Cost-Effectiveness of Reslizumab in Poorly Controlled Eosinophilic Asthma

Abstract

Evaluate the cost-effectiveness of reslizumab in the treatment of poorly controlled eosinophilic asthma Reslizumab may reduce the number of asthma exacerbations and improve the quality of life (QoL), but its cost-effectiveness is unclear. A five health state Markov model was used to compare the cost-effectiveness of add-on reslizumab therapy with the standard of care from the US societal perspective over a 5-year time horizon with a 3% annual discount rate. The five health states were chronic asthma, mild exacerbation, moderate exacerbation, severe exacerbation, and death. Treatment efficacy and safety inputs were based on aggregate data from two Phase 3 clinical trials (NCT01287039 and NCT01285323). Other model inputs, including mortality rates, costs, and utility were estimated from literature, the Centers for Disease Control and Prevention (CDC), the US Department of Veterans Affairs (VA) and the Centers for Medicare and Medicaid Services (CMS). One-way, threshold and probabilistic sensitivity analyses (PSA) were performed to test the robustness of model parameters. Adherence, treatment response, and the placebo effect were evaluated in separate scenario analyses. The base case incremental cost effectiveness ratio (ICER) was $697,403 per quality-adjusted life-year (QALY). In the PSA, reslizumab became cost-effective in 50% of the iterations at a willingness-to-pay (WTP) threshold of $689,000. One-way and threshold analyses showed that the model was most sensitive to the QoL improvement with reslizumab treatment and the cost of reslizumab. In the response and adherence models, the ICERs were lower than the base model ICER, but remained above $500,000. The ICER of the placebo effect of saline infusions was $29,820. The improvement in QoL and exacerbation rates with reslizumab are associated with high costs, making reslizumab unlikely to be cost-effective at the WTP threshold of $200,000. Similar results are likely with other new medications in this therapeutic category.