The cost-effectiveness evaluation of tezepelumab (TezspireR) for severe or refractory asthma treatment has yielded significant insights. This evaluation is crucial as it supports the use of tezepelumab for patients whose symptoms cannot be controlled with existing treatments. Tezepelumab has been reimbursed since November 2022 at specific prices for both syringe and pen formulations. These prices are based on a similar efficacy comparison method and include a usefulness premium of five percent. The drug is designated as an H1 cost-effectiveness evaluation item.
The evaluation was agreed upon at the first session of the Expert Committee of Cost-Effectiveness Evaluation (ECCEE). Tezepelumab is used to treat severe or refractory asthma without limitations on phenotype or biomarker. Dupilumab was selected as a comparator for the type 2 asthma population with eosinophil counts of at least 150/μL or IgE sensitization. The evaluation considered different populations; type 2 asthma with eosinophil counts ≥150/μL and IgE sensitization negative type 2 asthma with IgE sensitization positive and Non-type 2 asthma with eosinophil counts <150/μL and IgE sensitization negative. Comparators for these groups included existing biologics and standard care options such as beta-agonists and steroids.
The manufacturer conducted a systematic review of studies on asthma treatment tezepelumab and its comparators. While no direct randomized controlled trials (RCTs) compared asthma treatment tezepelumab with other biologics, four RCTs comparing it to placebo were identified. The NAVIGATOR trial, a Phase III study, was among these.
Evaluating Asthma Treatment: Cost-Effectiveness of Tezepelumab in Diverse Patient Groups
Three network meta-analyses (NMA) indirectly compared biologics. The manufacturer evaluated the additional benefits of tezepelumab based on the annual asthma exacerbation rate (AAER). For type 2 asthma with IgE sensitization negative, no studies met the definition, so additional benefits were not proven. However, for type 2 asthma with IgE sensitization positive, an NMA showed asthma treatment tezepelumab had superior efficacy. For non-type 2 asthma, benefits were proven by re-analyzing the NAVIGATOR trial.
The academic group found the manufacturer’s evaluation generally acceptable but noted uncertainty in the effectiveness differences between biologics due to varying indirect comparison methods. They highlighted the need for further data to validate the conclusions for the type 2 asthma population with eosinophil counts ≥150/μL and IgE sensitization negative.
The manufacturer used a Markov model with five health states: “well controlled”, “poorly controlled”, “exacerbation from good control”, “exacerbation from poor control”, and “death”. The transition probability to “death” was initially calibrated to a higher value based on a French epidemiological study. However, the academic group removed this calibration due to inconsistencies with Japanese epidemiological data. The cost-effectiveness analysis produced the following results
For type 2 asthma with eosinophil counts ≥150/μL and IgE sensitization negative, additional benefits were not proven, and the intervention led to a cost increase. For type 2 asthma with IgE sensitization positive, tezepelumab showed proven benefits with an incremental cost-effectiveness ratio (ICER) of 41,602,810 JPY/QALY. For non-type 2 asthma, the analysis focused on evaluating the additional benefits and cost implications.
Optimizing Asthma Treatment: Tezepelumab’s Cost-Effectiveness and the Need for Personalized Care
The evaluation concluded that while tezepelumab demonstrates cost-effectiveness in certain asthma populations, there remains significant variability in its effectiveness across different patient groups. This analysis underscores the importance of personalized treatment plans and the need for further research to solidify the findings.
The ECCEE’s decision to conduct this cost-effectiveness evaluation stems from a need to optimize treatment strategies for severe asthma. By thoroughly examining the benefits and costs associated with asthma treatment tezepelumab, the ECCEE aims to ensure that patients receive the most effective and economically viable treatments available. The findings from this evaluation will guide healthcare providers and policymakers in making informed decisions about the use of asthma treatment tezepelumab. By focusing on populations where the drug shows significant benefits, healthcare systems can allocate resources more efficiently and improve patient outcomes.
Further studies are necessary to address the uncertainties identified in the evaluation. Continued research and data collection will help refine the cost-effectiveness models and provide more robust evidence to support clinical decisions. As new therapies emerge, ongoing evaluations will be crucial in maintaining high standards of care and ensuring the sustainability of healthcare systems.
Resource: Center for Outcomes Research and Economic Evaluation for Health, June 12, 2024
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