Presentation (CTI)

OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating inflammatory disease characterized by persistent sinonasal symptoms, including nasal obstruction, discharge, facial pressure, and olfactory dysfunction. Biologic therapies control underlying type 2 inflammation and may be used in patients with inadequate response to initial treatments. Despite the need for disease control, access to biologic therapies remains limited in many healthcare systems, including the UK, primarily due to high treatment costs and uncertain cost-effectiveness. While biologics such as dupilumab have demonstrated superior clinical efficacy, reimbursement decisions are often driven by cost-effectiveness. Following EMA approval of CT-P39 (Omlyclo), the first omalizumab biosimilar, in May 2025, its lower cost warrants reassessment of cost-effectiveness in CRSwNP. The objective of this study is to evaluate the cost-effectiveness including omalizumab biosimilar for the treatment of CRSwNP.
METHODS: A cost-effectiveness model using quality-adjusted life-years(QALYs) was constructed using a Markov analysis from a public-payer perspective over a 10-year time horizon. A willingness-to-pay threshold of £20,000 was used to determine cost-effectiveness. Comparators included dupilumab, mepolizumab, and CT-P39.
RESULTS: CT-P39 was the most cost-effective biologic for CRSwNP. Over a 10-year horizon, total costs and QALYs were £52,042 and 5.83 for omalizumab biosimilar, £89,744 and 5.94 for dupilumab, and £52,425 and 5.63 for mepolizumab, respectively. Using omalizumab biosimilar as the reference strategy, dupilumab generated slightly higher QALYs at substantially higher cost, resulting in an ICER of £357,980 per QALY gained. Mepolizumab was dominated by omalizumab biosimilar. In probabilistic sensitivity analysis, dupilumab had only a 24% probability of being cost-effective versus omalizumab biosimilar at a willingness-to-pay threshold of £100,000 per QALY.
CONCLUSIONS: Despite the availability of highly efficacious biologics such as dupilumab, their high-cost limits patient access in real-world settings. CT-P39, a more cost-effective alternative, may facilitate broader access to biologic therapy and support addressing unmet treatment needs in CRSwNP, particularly in settings with restricted reimbursement.