OBJECTIVES : To critically review evidence on clinical and cost effectiveness of benralizumab (Fasenra^®) in adults with severe eosinophilic asthma, submitted by AstraZeneca to the National Institute for Health and Care Excellence (NICE) METHODS : AstraZeneca proposed a Markov model with a two-week cycle length and a lifetime time horizon. Benralizumab in combination with standard of care (SOC) was compared with mepolizumab+SOC, reslizumab+SOC and SOC alone in people with a blood eosinophil count of ≥300 cells/microliter, who had had ≥3 exacerbations in previous year or maintenance oral corticosteroids over previous six months. SIROCCO, CALIMA and ZONDA randomised control trials informed the comparison of benralizumab versus SOC. The clinical effectiveness of benralizumab compared with mepolizumab was based on a matched-adjusted indirect comparison analysis. In benralizumab versus reslizumab analysis, the treatments were assumed to be equally effective. The perspective was of the UK National Health Service and Personal Social Services. Costs and benefits were discounted at 3.5% per year. The company offered a Patient Access Scheme (PAS). RESULTS : The NICE committee noted that some people within the population considered by the company would be eligible for treatment with mepolizumab or reslizumab, and therefore the mixed population was not suitable for making decisions about the cost effectiveness of benralizumab relative to SOC. In an additional analysis for people not eligible for biologicals, the company’s and Evidence Review Group’s (ERG’s) incremental cost-effectiveness ratios (ICERs) for benralizumab versus SOC were £38,304 and £45,406 per quality-adjusted life-year (QALY) gained, respectively. In the ERG’s analysis for benralizumab versus mepolizumab in the mepolizumab-eligible population, the ICER, under PAS prices for the drugs, was below £20,000/QALY gained. In the reslizumab-eligible population, assuming PAS prices for benralizumab and reslizumab and clinical equivalence of these treatments, benralizumab was cost saving. CONCLUSIONS : Benralizumab is recommended by NICE in people with severe asthma eligible either for mepolizumab or reslizumab.