HEALTH AND ECONOMIC BURDEN OF DELAYED BIOLOGIC INITIATION IN SEVERE ASTHMA:A GLOBAL REAL-WORLD DATA-INFORMED DECISION MODEL
Author(s)
Graham Lough, PhD1, Helena Emery, PhD2, Job FM van Boven, PhD3, Wenjia Chen, PhD4, David Price, MD5, Ghislaine Scelo, PhD6, Julia F. Slejko, PhD7, Robert B. McQueen, BA, MA, PhD8.
1University of Leicester, Leicester, United Kingdom, 2Respiratory Effectiveness Group, Cambridgeshire, United Kingdom, 3University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 4National University of SIngapore, Singapore, Singapore, 5Observational & Pragmatic Research Institute, Singapore, Singapore, 6Observational & Pragmatic Research Institute, London, United Kingdom, 7University of Maryland Baltimore, Baltimore, MD, USA, 8Assistant Professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA.
1University of Leicester, Leicester, United Kingdom, 2Respiratory Effectiveness Group, Cambridgeshire, United Kingdom, 3University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 4National University of SIngapore, Singapore, Singapore, 5Observational & Pragmatic Research Institute, Singapore, Singapore, 6Observational & Pragmatic Research Institute, London, United Kingdom, 7University of Maryland Baltimore, Baltimore, MD, USA, 8Assistant Professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA.
OBJECTIVES: Biologics improve control and reduce exacerbations in severe asthma, yet many patients experience prolonged delays before receiving them. Understanding the clinical and economic implications of delayed initiation is increasingly important for service planning.
METHODS: We used International Severe Asthma Registry (ISAR) data from 26 countries, including 11,423 adults with severe asthma who initiated biologic therapy and had ≥12 months’ follow-up. Time to biologic was conceptualised from registry entry, then anchored to the earliest pre-biologic spirometry showing impaired lung function (FEV₁ <80% predicted or FEV₁/FVC <0.70). Among patients with qualifying spirometry (n = 4,145), we summarised delays overall and by early versus late initiation at the 75th percentile of lung function-based delay. Multinomial models related timing (late vs early on the registry-based scale) to exacerbations, hospitalisations, and emergency department (ED) visits across 1-2, 3-4, and 4-5 years, adjusted for prior exacerbations, oral corticosteroid exposure, and a biologic access score. Relative risks from these models were applied in a validated lifetime asthma model to quantify downstream health loss, expressed as quality-adjusted life-years (QALYs), and to contextualise the potential long-term impact of delayed escalation.
RESULTS: Among 4,145 patients with impaired pre-biologic spirometry, the median time from earliest recorded impairment to biologic initiation was 0.39 years (IQR 0.02-1.76). One quarter experienced substantial delays, with the late group showing a median 4.76-year delay (IQR 2.78-7.49, maximum 16.0). Late initiation was consistently associated with higher exacerbation burden, with unadjusted relative risks for ≥1 exacerbation up to 2.16 across follow-up in the first 1-2 years. Lifetime modelling suggested that a 1.3-year delay resulted in a loss of 0.056 QALYs (≈20 days of perfect health).
CONCLUSIONS: Later initiation of biologics is associated with a higher exacerbation burden and meaningful long-term health losses, underscoring the need for earlier referral and service pathways that support timely biologic access.
METHODS: We used International Severe Asthma Registry (ISAR) data from 26 countries, including 11,423 adults with severe asthma who initiated biologic therapy and had ≥12 months’ follow-up. Time to biologic was conceptualised from registry entry, then anchored to the earliest pre-biologic spirometry showing impaired lung function (FEV₁ <80% predicted or FEV₁/FVC <0.70). Among patients with qualifying spirometry (n = 4,145), we summarised delays overall and by early versus late initiation at the 75th percentile of lung function-based delay. Multinomial models related timing (late vs early on the registry-based scale) to exacerbations, hospitalisations, and emergency department (ED) visits across 1-2, 3-4, and 4-5 years, adjusted for prior exacerbations, oral corticosteroid exposure, and a biologic access score. Relative risks from these models were applied in a validated lifetime asthma model to quantify downstream health loss, expressed as quality-adjusted life-years (QALYs), and to contextualise the potential long-term impact of delayed escalation.
RESULTS: Among 4,145 patients with impaired pre-biologic spirometry, the median time from earliest recorded impairment to biologic initiation was 0.39 years (IQR 0.02-1.76). One quarter experienced substantial delays, with the late group showing a median 4.76-year delay (IQR 2.78-7.49, maximum 16.0). Late initiation was consistently associated with higher exacerbation burden, with unadjusted relative risks for ≥1 exacerbation up to 2.16 across follow-up in the first 1-2 years. Lifetime modelling suggested that a 1.3-year delay resulted in a loss of 0.056 QALYs (≈20 days of perfect health).
CONCLUSIONS: Later initiation of biologics is associated with a higher exacerbation burden and meaningful long-term health losses, underscoring the need for earlier referral and service pathways that support timely biologic access.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE423
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)