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Cost-Effectiveness Analysis of Treatments for Children With Uncontrolled Asthma Symptoms Despite Inhaled
Giovanna Culeddu1, Sofia Cividini2, Ian Sinha3
1Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK.
Insights
Treatment escalation for uncontrolled childhood asthma in the UK is not cost-effective unless medication prices decrease or therapy targets high-risk patients. Further research into inhaled corticosteroid (ICS) and long-acting beta2-agonist (LABA) cost-effectiveness is needed.
Area of Science:
- Health Economics
- Pediatric Pulmonology
- Pharmacoeconomics
Background:
- Uncontrolled asthma in children and adolescents despite inhaled corticosteroid (ICS) treatment presents significant management challenges.
- The cost-effectiveness of various treatment escalation strategies remains uncertain within healthcare systems like the UK's National Health Service (NHS).
Purpose of the Study:
- To evaluate the cost-effectiveness of different asthma treatment options for pediatric patients with uncontrolled asthma.
- To compare low-dose ICS, medium-dose ICS, high-dose ICS, ICS/long-acting β2-adrenoceptor agonist (LABA), and leukotriene receptor antagonist (LTRA) therapies.
Main Methods:
- A Markov state-transition model was employed to simulate costs and health outcomes over a 1-year time horizon from an NHS perspective.
- Data on healthcare resource use and utilities were sourced from literature reviews.
- Transition probabilities were determined through a systematic review and network meta-analysis.
Main Results:
- Medium-dose ICS and ICS/LABA showed incremental cost-effectiveness ratios (ICERs) of £255,555 and £304,956 per quality-adjusted life year (QALY) gained, respectively, compared to low-dose ICS.
- High-dose ICS, LTRA monotherapy, and combination LTRA/ICS were dominated by less costly, more effective alternatives.
- The ICER for medium-dose ICS improved significantly to £14,797/QALY with increased exacerbation risk probabilities, and ICS/LABA became cost-effective with a >60% price reduction.
Conclusions:
- Escalating asthma treatment beyond low-dose ICS in UK children may only be cost-effective if alternative medication prices decrease.
- Targeting escalated treatments to patients at higher risk of asthma exacerbations could improve cost-effectiveness.
- The findings highlight the need for careful consideration of treatment costs and patient risk profiles in managing pediatric asthma.
Introduction:
There is uncertainty about the cost-effectiveness of treatment options for children and adolescents with uncontrolled asthma despite inhaled corticosteroid (ICS) treatment.
Methods:
A Markov state-transition model was developed to simulate costs from the perspective of the National Health Service in the UK and health outcomes associated with low, medium and high dose ICS, ICS in combination with long-acting β2-adrenoceptor agonists (LABAs) or leukotriene receptor antagonists (LTRAs), and LTRA monotherapy. Healthcare resource use and health state utilities were identified from literature searches. Transition probabilities were derived from a systematic review and network meta-analysis. Total costs and quality-adjusted life years were computed, and incremental cost-effectiveness ratios estimated over a 1-year time horizon. Parameter, structural and probabilistic sensitivity analyses were performed.
Results:
Compared with low-dose ICS, medium-dose ICS and ICS + LABA had incremental cost-effectiveness ratios of £255,555 and £304,956 per quality-adjusted life year gained, respectively. High-dose ICS, LTRA alone and in combination with ICS were dominated by alternatives which were less costly and associated with a greater number of quality-adjusted life years. The incremental cost-effectiveness ratio for medium-dose ICS reduced to £14,797 per quality-adjusted life year gained when the transition probabilities were increased to reflect a higher risk of asthma exacerbation. ICS + LABA became cost effective with a > 60% reduction in inhaler price.
Conclusions:
Treatment escalation beyond low-dose ICS in children and adolescents with uncontrolled asthma may only be cost-effective in the UK if the prices of alternatives reduce or treatment is targeted to those at higher risk of asthma exacerbations.
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