OBJECTIVES

Severe, uncontrolled asthma is associated with a high disease burden and has been a priority area of research for new treatments, with several biologics recently becoming available and others in development. It is critical for payers and Health Technology Assessment (HTA) agencies to understand the cost-effectiveness of biologic treatments using economic modelling. This research aims to summarize and to compare economic models used by HTA agencies to assess biologics in severe asthma.

METHODS

We conducted targeted literature searches (January 2010–September 2019) of the websites of key HTA bodies (NICE, CADTH, PBAC, TLV, ICER). Included studies reported economic models used in populations with moderate or severe asthma (GINA Step 4 or Step 5).

RESULTS

Of 88 identified articles, 16 were found to be relevant for full review (NICE: 4, CADTH: 7, PBAC: 4, TLV: 0, ICER: 1). Included studies covered a range of biologic treatments indicated for severe asthma (omalizumab: 3, mepolizumab: 5, reslizumab: 3, benralizumab: 4, multiple biologics: 1). The 16 studies yielded 10 unique economic models. Most reports (15/16) focused on severe eosinophilic or severe persistent asthma populations. All of the models reviewed used standard-of-care treatment as a comparator. Approximately 60% of the models also made a comparison with at least one other biologic treatment, the most common being omalizumab. Model structures differed among agencies. Common features were the inclusion of exacerbation health states (all models), inclusion of a stopping rule or response assessment (7/10) and inclusion of controlled/uncontrolled health states (2/10). Exact assumptions differed across agencies.

CONCLUSIONS

Despite a common definition of the decision problem (population, comparators), HTA agencies had differing approaches to economic modelling of severe asthma. It is critical that HTA agencies carefully assess the level of information available and adopt model structures that capture the value of biologic treatments in their health system.