Discrete-Event Simulation Model Projects Economic Outcomes Associated with Long-Term Clinical Remission in Patients with Severe Asthma Receiving Mepolizumab
Author(s)
Kejsi Begaj, PharmD1, Alan Martin, MSc2, Samantha N. Valliant, PharmD1, Niels Dunnewind, MSc3, Matthew Knowles, MMath4, Disha Jain, MSc5, Martijn J.H.G. Simons, MSc3, Craig Bennison, MSc4, Rafael Alfonso-Cristancho, PhD1.
1Global Real-World Evidence and Health Outcomes Research, GSK, Collegeville, PA, USA, 2Global Real-World Evidence and Health Outcomes Research, GSK, London, United Kingdom, 3Evidence and Access, OPEN Health, Rotterdam, Netherlands, 4Evidence and Access, OPEN Health, London, United Kingdom, 5Evidence and Access, OPEN Health, New Delhi, India.
1Global Real-World Evidence and Health Outcomes Research, GSK, Collegeville, PA, USA, 2Global Real-World Evidence and Health Outcomes Research, GSK, London, United Kingdom, 3Evidence and Access, OPEN Health, Rotterdam, Netherlands, 4Evidence and Access, OPEN Health, London, United Kingdom, 5Evidence and Access, OPEN Health, New Delhi, India.
Presentation Documents
OBJECTIVES: Clinical remission (CR) is an ambitious and achievable goal in severe asthma. Mepolizumab, a monoclonal anti-interleukin-5 antibody, has been shown to help patients achieve CR. We developed an exploratory model projecting long-term economic impacts of CR attainment with mepolizumab.
METHODS: A novel, patient-level, discrete-event simulation model was developed using regression equations to estimate CR attainment, maintenance or loss over time. Patients were considered in remission if they adhered to four components concurrently for 1 year of treatment: exacerbation-free; Asthma Control Questionnaire-5 score <1.5; % predicted forced expiratory volume (mL) in 1 second ≥80%; no maintenance oral corticosteroid (OCS) use. Data from 90 adult patients with complete data receiving mepolizumab 100 mg Q4W for 2 years in the REALITI-A study were used to develop predictive equations for CR components during the study. Mepolizumab effectiveness in REALITI-A was the base case. Scenario analyses examined the effects of varying time horizons and societal perspectives. Costs were inflated to 2023 US dollars.
RESULTS: Mean discounted (3%) costs-per-patient treated with mepolizumab within a lifetime horizon were $168,995. Treatment acquisition ($144,076) and maintenance OCS ($20,516) were the main cost drivers. In the base case, 29.5% of patients were projected to attain CR at Year 1. At Year 1, undiscounted costs-per-patient were higher for those not in remission versus in remission both when treatment costs were excluded ($4,751 vs $1,724) and when treatment costs were included ($52,600 vs $49,871). In scenario analyses of patients in CR, costs-per-patient at 3-, 5- and 10-year horizons were $104,293, $123,220 and $144,391, respectively. Analysis from a societal perspective including productivity losses increased total lifetime costs to $186,221 per patient.
CONCLUSIONS: This study modelled the impact of mepolizumab on CR attainment and predicted that economic benefits are associated with CR. This is important considering the high overall economic burden observed in severe asthma.
METHODS: A novel, patient-level, discrete-event simulation model was developed using regression equations to estimate CR attainment, maintenance or loss over time. Patients were considered in remission if they adhered to four components concurrently for 1 year of treatment: exacerbation-free; Asthma Control Questionnaire-5 score <1.5; % predicted forced expiratory volume (mL) in 1 second ≥80%; no maintenance oral corticosteroid (OCS) use. Data from 90 adult patients with complete data receiving mepolizumab 100 mg Q4W for 2 years in the REALITI-A study were used to develop predictive equations for CR components during the study. Mepolizumab effectiveness in REALITI-A was the base case. Scenario analyses examined the effects of varying time horizons and societal perspectives. Costs were inflated to 2023 US dollars.
RESULTS: Mean discounted (3%) costs-per-patient treated with mepolizumab within a lifetime horizon were $168,995. Treatment acquisition ($144,076) and maintenance OCS ($20,516) were the main cost drivers. In the base case, 29.5% of patients were projected to attain CR at Year 1. At Year 1, undiscounted costs-per-patient were higher for those not in remission versus in remission both when treatment costs were excluded ($4,751 vs $1,724) and when treatment costs were included ($52,600 vs $49,871). In scenario analyses of patients in CR, costs-per-patient at 3-, 5- and 10-year horizons were $104,293, $123,220 and $144,391, respectively. Analysis from a societal perspective including productivity losses increased total lifetime costs to $186,221 per patient.
CONCLUSIONS: This study modelled the impact of mepolizumab on CR attainment and predicted that economic benefits are associated with CR. This is important considering the high overall economic burden observed in severe asthma.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
MSR48
Topic
Methodological & Statistical Research
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Biologics & Biosimilars