Economic Analysis of Dupilumab Use in Patients With Chronic Rhinosinusitis With Nasal Polyps in Colombia

OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease of the nasal cavity and paranasal associated with a high treatment and symptoms burden. Evidence suggests that after the initial surgery, polyps tend to recur, often in severe CRSwNP. Treatment with Dupilumab significantly improves clinical and patient-reported outcomes. This study aims to estimate the cost per responder using existing therapies in Colombia.

METHODS: A cost-analysis model was developed using an indirect treatment comparison between dupilumab and omalizumab. The outcome of interest was the cost per responder achieving NPS>2 for a 1-year time horizon. Discontinuation rule was applied based on response rates for dupilumab and omalizumab at week 24. Drug acquisition, revision surgery, and adverse events (AE) costs were included in the analysis. Costs and clinical data for AE and surgery were extracted from published literature.

The analysis was developed for a hypothetical cohort of 100 patients with CRSwNP with prior surgery without response, initiating biologic therapy from the healthcare system perspective. All costs are expressed in USD$ using an exchange rate of COP$4,700 per USD$1.

RESULTS: The total treatment cost of dupilumab was higher than omalizumab ($843,387 vs. $272,686); however, a higher response rate was observed with dupilumab (46.1% vs. 7.1%). The costs associated with AE per responder for dupilumab were 83% lower than omalizumab ($1,494 vs. $8,925). Total surgery costs for dupilumab were lower than omalizumab ($6,005 vs $8,953).

The cost per responder driven by the difference in effectiveness in NPS>2 between dupilumab and omalizumab results in a 59.4% lower cost for dupilumab ($19,919 vs $49,017).

CONCLUSIONS: Results suggest that treating CRSwNP patients with dupilumab is a less costly alternative to omalizumab, considering cost per responder approach achieving NPS > 2 in those patients suggesting better value for money.