COST-EFFECTIVENESS OF TEZEPELUMAB VERSUS DUPILUMAB AND MEPOLIZUMAB IN PATIENTS WITH CHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSWNP) IN SPAIN
Author(s)
Alfonso Del Cuvillo, MD, PhD1, LUIS CARLOS FERNANDEZ LISON, PhD2, Sara García Gil, Ms3, Ruperto González Pérez, MD, PhD4, Covadonga Torres, Ms5, Laura Contreras-Bernal, Ms5, Carla Garí-Peris, Ms6, Neus Vidal-Vilar, Ms6, José Luis Izquierdo Alonso, MD7.
1Rhinology and Asthma Unit, Department of Otolaryngology–Head and Neck Surgery, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain, 2Hospital Pharmacy Department, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain, 3Department of Pharmacy, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain, 4Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain, 5AstraZeneca Farmacéutica Spain, Madrid, Spain, 6Outcomes'10 (A ProductLife Group Company), Castellón de la Plana, Spain, 7Respiratory Medicine; Department of Medicine and Medical Specialties, University Hospital of Guadalajara; University of Alcalá, Madrid, Spain.
1Rhinology and Asthma Unit, Department of Otolaryngology–Head and Neck Surgery, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain, 2Hospital Pharmacy Department, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain, 3Department of Pharmacy, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain, 4Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain, 5AstraZeneca Farmacéutica Spain, Madrid, Spain, 6Outcomes'10 (A ProductLife Group Company), Castellón de la Plana, Spain, 7Respiratory Medicine; Department of Medicine and Medical Specialties, University Hospital of Guadalajara; University of Alcalá, Madrid, Spain.
OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with impaired quality of life, increased oral corticosteroid (OCS) use and higher healthcare utilization, principally surgery. To assess the cost-effectiveness of tezepelumab plus standard of care (SoC) versus dupilumab and mepolizumab plus SoC in biologic-eligible adults with inadequately controlled CRSwNP from the Spanish National Health System (NHS) perspective.
METHODS: A 20-year Markov model with 6-month cycles (3% annual discount rate) was developed. Health states reflected CRSwNP severity based on SNOT-22 categories (mild, moderate, and severe), surgery, post-surgery states, and death. Tezepelumab transition probabilities were informed by WAYPOINT (mean age 49.7 years; 34.8% female), while those for dupilumab and mepolizumab were derived from a systematic network meta-analysis of randomized trials using SNOT-22 and response outcomes across follow-up periods (≥30 and <30 weeks), with placebo as comparator and assuming proportional effects on transition probabilities. Health-state utilities were estimated from WAYPOINT EQ-5D data and mapped to SNOT-22 categories; disutilities for OCS-related adverse events were applied. Costs included drug acquisition (list price), disease management, surgery, and OCS-related adverse events (€,2025). Spanish data were used where available and validated by a Spanish expert panel. Outcomes included quality-adjusted life-years (QALYs), costs and probabilistic sensitivity analyses (PSA).
RESULTS: Tezepelumab was dominant versus comparators. Compared with dupilumab, tezepelumab generated 9.93 vs 9.61 QALYs (+0.32) and reduced costs by €3,071 (€176,453 vs €179,523). Compared with mepolizumab, tezepelumab generated +0.46 QALYs (9.93 vs 9.46) and saved €220 (€176,453 vs €176,673). In PSA, tezepelumab was cost-effective or dominant in 73.2% and 77.0% of simulations versus dupilumab and mepolizumab, respectively (cost-effective in 17.6% and 26.5%, and dominant in 55.6% and 50.5%), at a willingness-to-pay threshold of €30,000/QALY.
CONCLUSIONS: Tezepelumab appears to be a dominant option versus dupilumab and mepolizumab in biologic-eligible adults with CRSwNP, providing greater health benefits at lower costs, from the Spanish NHS perspective.
METHODS: A 20-year Markov model with 6-month cycles (3% annual discount rate) was developed. Health states reflected CRSwNP severity based on SNOT-22 categories (mild, moderate, and severe), surgery, post-surgery states, and death. Tezepelumab transition probabilities were informed by WAYPOINT (mean age 49.7 years; 34.8% female), while those for dupilumab and mepolizumab were derived from a systematic network meta-analysis of randomized trials using SNOT-22 and response outcomes across follow-up periods (≥30 and <30 weeks), with placebo as comparator and assuming proportional effects on transition probabilities. Health-state utilities were estimated from WAYPOINT EQ-5D data and mapped to SNOT-22 categories; disutilities for OCS-related adverse events were applied. Costs included drug acquisition (list price), disease management, surgery, and OCS-related adverse events (€,2025). Spanish data were used where available and validated by a Spanish expert panel. Outcomes included quality-adjusted life-years (QALYs), costs and probabilistic sensitivity analyses (PSA).
RESULTS: Tezepelumab was dominant versus comparators. Compared with dupilumab, tezepelumab generated 9.93 vs 9.61 QALYs (+0.32) and reduced costs by €3,071 (€176,453 vs €179,523). Compared with mepolizumab, tezepelumab generated +0.46 QALYs (9.93 vs 9.46) and saved €220 (€176,453 vs €176,673). In PSA, tezepelumab was cost-effective or dominant in 73.2% and 77.0% of simulations versus dupilumab and mepolizumab, respectively (cost-effective in 17.6% and 26.5%, and dominant in 55.6% and 50.5%), at a willingness-to-pay threshold of €30,000/QALY.
CONCLUSIONS: Tezepelumab appears to be a dominant option versus dupilumab and mepolizumab in biologic-eligible adults with CRSwNP, providing greater health benefits at lower costs, from the Spanish NHS perspective.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE727
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)