THE DYNAMICS OF EXACERBATION-RELATED HEALTH-STATE TRANSITIONS IN UNCONTROLLED ASTHMA: A MARKOV-BASED MULTI-CRITERIA ANALYSIS
Author(s)
Frederico Sallum, MSc1, ELIO TANAKA, MD2;
1Chiesi, Head of Health Economics, São Paulo, Brazil, 2TNK MEDICAL AUDIT INSTITUTION, CURITIBA, Brazil
1Chiesi, Head of Health Economics, São Paulo, Brazil, 2TNK MEDICAL AUDIT INSTITUTION, CURITIBA, Brazil
OBJECTIVES: Asthma exacerbations represent a major driver of healthcare resource utilization, imposing a substantial burden on healthcare systems. This study aimed to identify cycle-specific clinically meaningful (CM) transitions between exacerbation-related health states in adult patients with asthma by analyzing Markov chains for medium-strength (MS) and high-strength (HS) single-inhaler triple therapy (SITT) with beclometasone, formoterol, and glycopyrronium (BDP/FOR/GLY), in order to characterize expected clinical trajectories and disease dynamics over time.
METHODS: Published Markov chains of adult patients with uncontrolled asthma despite prior inhaled corticosteroids plus long-acting beta-agonists treatment were analyzed. The Markov models evaluated MS and HS SITT with BDP/FOR/GLY over a 52-week horizon divided into five cycles. Health states were defined as no exacerbation, moderate exacerbation, severe exacerbation, and severe exacerbation with hospitalization. Transition probabilities were informed by two randomized clinical trials. The Weighted Influence Non-linear Gauge System (WINGS), a method within the multi-criteria decision analysis framework, was applied to identify CM transitions by considering each health state as a system element, probabilities of remaining in each health state as element strength, and transition probabilities as directional influence between elements.
RESULTS: Remaining in the no exacerbation state and transitions from moderate exacerbation and severe exacerbation to no exacerbation were identified as CM across all cycles for both MS and HS BDP/FOR/GLY. The transition from severe exacerbation with hospitalization to no exacerbation were identified as CM throughout all cycles only for HS BDP/FOR/GLY. No clinically meaningful progression transitions were identified for either therapy over the full treatment period.
CONCLUSIONS: Both MS and HS BDP/FOR/GLY were highly effective in controlling asthma in the studied patient population. HS BDP/FOR/GLY was associated with more favorable recovery pathways at specific stages of treatment.
METHODS: Published Markov chains of adult patients with uncontrolled asthma despite prior inhaled corticosteroids plus long-acting beta-agonists treatment were analyzed. The Markov models evaluated MS and HS SITT with BDP/FOR/GLY over a 52-week horizon divided into five cycles. Health states were defined as no exacerbation, moderate exacerbation, severe exacerbation, and severe exacerbation with hospitalization. Transition probabilities were informed by two randomized clinical trials. The Weighted Influence Non-linear Gauge System (WINGS), a method within the multi-criteria decision analysis framework, was applied to identify CM transitions by considering each health state as a system element, probabilities of remaining in each health state as element strength, and transition probabilities as directional influence between elements.
RESULTS: Remaining in the no exacerbation state and transitions from moderate exacerbation and severe exacerbation to no exacerbation were identified as CM across all cycles for both MS and HS BDP/FOR/GLY. The transition from severe exacerbation with hospitalization to no exacerbation were identified as CM throughout all cycles only for HS BDP/FOR/GLY. No clinically meaningful progression transitions were identified for either therapy over the full treatment period.
CONCLUSIONS: Both MS and HS BDP/FOR/GLY were highly effective in controlling asthma in the studied patient population. HS BDP/FOR/GLY was associated with more favorable recovery pathways at specific stages of treatment.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA50
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)