OBJECTIVES: Lack of head-to-head trials between biologics hinders payers from offering accessible treatments, thereby limiting patients' access to cost-effective therapies. The present analysis compared the number needed to treat (NNT) and cost-per-event avoided (CPEA) for dupilumab versus omalizumab, benralizumab, and mepolizumab in preventing asthma exacerbation in Italy for a 1-year period.

METHODS: An economic tool was adapted from Italian perspective to analyse the NNT to avoid one severe exacerbation and corresponding CPEA/year. Efficacy data were derived from real-world evidence (RWE; US-ADVANTAGE). In the base case, NNT was compared between dupilumab versus mepolizumab and benralizumab (among patients with ≥2 severe exacerbations) and versus omalizumab (among patients with ≥1 severe exacerbation). The CPEA/year was computed by multiplying treatment costs (biologic and administration costs) by the NNT to obtain corresponding 1-year incremental cost to avoid one severe exacerbation. Costs were sourced from Italian drug prices listed in the official gazette. Results were further analysed within a matched cohort of biologics, derived from a published indirect treatment comparison (ITC), to eliminate potential bias associated with the inclusion of a single study. Sensitivity analyses (SA) with varying discounting scenarios (20%, 30% and 40%) were applied.

RESULTS: Dupilumab demonstrated a lower NNT to avoid one severe exacerbation than omalizumab (0.6 vs. 1.1), benralizumab (0.5 vs. 0.8), and mepolizumab (0.5 vs. 0.9), respectively, as derived from RWE. The CPEA/year was lower for dupilumab vs. other biologics, with a 1-year incremental cost of €6,2K for omalizumab, €4,8K for benralizumab and €6,0K for mepolizumab, relative to dupilumab. The ITC study, involving clinical trial data, revealed consistent results for NNT and CPEA/year (€10,7K: omalizumab, €9,6K: benralizumab, €2,5K: mepolizumab). Additionally, SA confirmed a lower incremental CPEA/year with dupilumab in all discounting scenarios.

CONCLUSIONS: In our model, dupilumab demonstrated lower NNT and CPEA/year versus other asthma biologics for avoiding severe exacerbations in patients with moderate-to-severe asthma.