OBJECTIVES: Several biologics have been proven to be effective in reducing asthma exacerbations; yet their cost implication data are limited. This study evaluated exacerbation-related healthcare costs (HCs) associated with dupilumab vs. other biologics in patients with asthma.

METHODS: An Excel-based economic model was developed to compare HCs associated with dupilumab vs. benralizumab, omalizumab, and mepolizumab over a 1-year time horizon from a US payer perspective, without taking the biologic costs into consideration. The per-patient year (PPY) cost of severe asthma exacerbations, defined as asthma-related event that requires an oral corticosteroid burst, or emergency department (ED) visit, or hospitalization, was calculated. In base case, net cost differences were determined by comparing inpatient, outpatient, and ED visit costs in patients with ≥1 (vs. omalizumab) and ≥2 (vs. benralizumab and mepolizumab) asthma exacerbations in the prior year. Annual severe exacerbation rates were derived from the US-ADVANTAGE real-world study. Costs (2023 US$) were sourced from published data/wholesale prices. Scenario analysis included costs of systemic corticosteroids (SCS) and SCS-related adverse events. One-way sensitivity analyses (OWSA) of key parameters, and Monte Carlo simulations to estimate 95% confidence interval (CI) for the mean cost difference were conducted.

RESULTS: Dupilumab demonstrated lower HCs PPY in the base case, with a cost difference (95% CI) of $2,400 ($1,074; $4,268) vs. omalizumab, $2,305 ($866; $4,282) vs. benralizumab, and $2,839 ($1,182; $5,142) vs. mepolizumab. Additional cost reductions were observed for dupilumab in scenario analyses (cost differences: $2,566 vs. omalizumab; $2,439 vs. benralizumab; and $3,073 vs. mepolizumab). OWSA estimates showed that the base case HCs difference was more sensitive to changes in exacerbation incidence rate ratios. Results from Monte Carlo simulations further showed lower exacerbation-related HCs for dupilumab compared with other biologics, confirming the robustness of the results.

CONCLUSIONS: Dupilumab was associated with lower severe asthma exacerbations-related costs than omalizumab, benralizumab or mepolizumab.