OBJECTIVES: To compare the cost-effectiveness of dupilumab, mepolizumab and benralizumab for the treatment of patients with severe eosinophilic asthma using ICS-LABA with baseline blood eosinophil count ≥ 300 cells/mcl and three or more episodes of asthma exacerbation, or corticosteroid-maintenance, in the previous year, in the Brazilian private healthcare perspective.

METHODS: Lifetime horizon Markov model was used to conduct a cost-effectiveness analysis. The base-case analysis was performed considering demographic and clinical data from ProAr Brazilian cohort of asthma patients. We conducted three independent systematic reviews to assess the effectiveness of each intervention, compared to standard of care (SC), for the population of interest. The following costs were considered, under the Brazilian private healthcare setting: treatment with immunobiologicals (i.e., drugs and administration costs), costs related to the disease (i.e., clinical visits) and complication management (i.e., hospitalization). Five percent yearly discount rate was applied for costs and effectiveness. Reference costs were from 31 August 2021, with USD1.00 equivalent to BRL5.1427.

RESULTS: In the base-case, dupilumab was more effective and more expensive than benralizumab, mepolizumab and SC (+0.76, +0.85 and +2.74 QALYs; +USD67,639, +USD35,340 and +USD268,184, respectively). The incremental cost-effectiveness ratio (ICER) for mepolizumab and benralizumab, compared to SC, were USD123,687/QALY and USD101,698/QALY, with benralizumab presenting strong dominance over mepolizumab. The ICER for dupilumab compared to mepolizumab, benralizumab and SC were USD41,433/QALY, USD88,592/QALY and USD98,040/QALY, respectively, with dupilumab presenting extended dominance over mepolizumab and benralizumab.

CONCLUSIONS: Currently, dupilumab, benralizumab and mepolizumab are reimbursed by private health insurance plans in Brazil for severe eosinophilic asthma. Based on our analysis, dupilumab is cost-effective when compared to benralizumab and mepolizumab, supported by its extended dominance over these two immunobiologic agents. The finding that dupilumab is more effective with a lower ICER compared to mepolizumab and benralizumab is an important driver in the healthcare decision-making process framework.