Presentation (CTI)

OBJECTIVES: To evaluate the cost-effectiveness of biologic therapies compared with standard of care (SoC) in adults with severe uncontrolled eosinophilic asthma (blood eosinophils ≥150 cells/µL).
METHODS: A Markov model with 2-week cycles simulated adults with severe uncontrolled eosinophilic asthma over one year from a U.S. payer perspective. Health states included non-exacerbation, exacerbation, asthma-related mortality, and other causes of mortality. Biologic therapies added to SoC were compared with SoC alone. Clinical inputs were obtained from published randomized controlled trials. Costs (2024 USD) reflected asthma-related utilization using net prices and were adjusted using the U.S. medical Consumer Price Index. Health outcomes were measured using quality-adjusted life-years (QALYs). Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) interpreted at willingness-to-pay (WTP) thresholds of $100,000-$150,000 per QALY, with net health benefit (NHB) estimated at a WTP threshold of $150,000 per QALY.
RESULTS: Compared with SoC alone, biologic therapies increased costs and modestly improved health outcomes. Dupilumab plus SoC resulted in an incremental cost of $32,500 and a gain of 0.044 QALYs, yielding an ICER of $737,000 per QALY. Tezepelumab plus SoC resulted in an incremental cost of $44,300 and a gain of 0.052 QALYs, resulting in an ICER of $845,000 per QALY. At a WTP threshold of $150,000 per QALY, NHB was negative for both biologic therapies, with dupilumab demonstrating a less negative NHB.
CONCLUSIONS: In adults with severe uncontrolled eosinophilic asthma, biologic therapies improved health outcomes but were associated with higher costs. Under base-case assumptions and current net prices, neither biologic strategy was cost-effective at commonly cited U.S. WTP thresholds. These findings underscore the importance of biologic acquisition costs and suggest that future price changes may alter cost-effectiveness conclusions. Inclusion of the societal perspective and the long-term deleterious impact of corticosteroids may improve the cost-effectiveness of biologics and will be included in future analyses.