CLINICAL-ECONOMIC EVALUATION OF INTEGRATED STRATEGIES FOR SEVERE ASTHMA MANAGEMENT IN ITALY: A MULTIDIMENSIONAL PREDICTIVE APPROACH
Author(s)
Filippo Rumi, MA, MSc1, Debora Antonini, PhD1, Matteo Bonini, PhD2, CANONICA GIORGIO WALTER, PhD3.
1Altems Advisory, Università Cattolica del Sacro Cuore, Rome, Italy, 2Sapienza University of Rome, Rome, Italy, 3Humanitas University & Research Hospital, Milan, Italy.
1Altems Advisory, Università Cattolica del Sacro Cuore, Rome, Italy, 2Sapienza University of Rome, Rome, Italy, 3Humanitas University & Research Hospital, Milan, Italy.
OBJECTIVES: Severe asthma imposes a clinical, social, and economic burden, as access to biologic therapies expands. This study assessed the clinical, economic, social, and fiscal impact of three policy strategies for severe asthma management: (i) improved treatment adherence, (ii) expanded biologic access, and (iii) earlier disease identification with structured care, using a multidimensional predictive modeling framework.
METHODS: A combined approach integrated a Budget Impact Analysis (BIA), a cost-of-illness (COI) model, and an annual Markov model over a five-year horizon, from NHS, societal, and fiscal perspectives. The Markov model included four states: mild, moderate, severe asthma, and death. The target population comprised Italian adults with asthma (~426,000 with severe disease). Key inputs included drug costs, healthcare resource use, and exacerbation rates derived from national sources and published evidence.
RESULTS: The baseline scenario showed progressive cost growth, totaling ~€133 billion over five years, largely driven by exacerbation management and productivity losses. Policy 1 (improved adherence: +10.5 percentage points for inhaled therapies, +10 for biologics) generated cumulative savings of €5.03 billion, mainly through reduced productivity losses (-€4.40 billion) and exacerbation costs (-€1.27 billion), emerging as the most efficient strategy. Policy 2 (biologic market share from 10% to 16%) increased overall expenditure by €5.46 billion due to higher drug costs, partially offset by fewer exacerbations (-€437 million). Policy 3 (earlier identification, 20% reduction in disease progression rates) yielded savings of €3.62 billion. The integrated scenario combining all strategies generated a net cumulative saving of €3.51 billion, with consistent benefits across all perspectives.
CONCLUSIONS: Integrated care pathways—combining early diagnosis, improved adherence, multidisciplinary management, and appropriate biologic use—represent the most effective and sustainable strategy for severe asthma in Italy. These findings support a shift from reactive to integrated, prevention-oriented asthma management policies, maximizing both health outcomes and long-term system sustainability.
METHODS: A combined approach integrated a Budget Impact Analysis (BIA), a cost-of-illness (COI) model, and an annual Markov model over a five-year horizon, from NHS, societal, and fiscal perspectives. The Markov model included four states: mild, moderate, severe asthma, and death. The target population comprised Italian adults with asthma (~426,000 with severe disease). Key inputs included drug costs, healthcare resource use, and exacerbation rates derived from national sources and published evidence.
RESULTS: The baseline scenario showed progressive cost growth, totaling ~€133 billion over five years, largely driven by exacerbation management and productivity losses. Policy 1 (improved adherence: +10.5 percentage points for inhaled therapies, +10 for biologics) generated cumulative savings of €5.03 billion, mainly through reduced productivity losses (-€4.40 billion) and exacerbation costs (-€1.27 billion), emerging as the most efficient strategy. Policy 2 (biologic market share from 10% to 16%) increased overall expenditure by €5.46 billion due to higher drug costs, partially offset by fewer exacerbations (-€437 million). Policy 3 (earlier identification, 20% reduction in disease progression rates) yielded savings of €3.62 billion. The integrated scenario combining all strategies generated a net cumulative saving of €3.51 billion, with consistent benefits across all perspectives.
CONCLUSIONS: Integrated care pathways—combining early diagnosis, improved adherence, multidisciplinary management, and appropriate biologic use—represent the most effective and sustainable strategy for severe asthma in Italy. These findings support a shift from reactive to integrated, prevention-oriented asthma management policies, maximizing both health outcomes and long-term system sustainability.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE257
Topic
Economic Evaluation, Epidemiology & Public Health, Organizational Practices
Topic Subcategory
Budget Impact Analysis, Work & Home Productivity - Indirect Costs
Disease
Biologics & Biosimilars, No Additional Disease & Conditions/Specialized Treatment Areas, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)