OBJECTIVES: To compare the treatment costs of dupilumab and omalizumab for severe allergic asthma patients in the Brazilian private healthcare perspective.

METHODS: While dupilumab dosing is fixed, omalizumab dosing (and, therefore, treatment cost), varies according to patient’s body weight and serum IgE level. Thus, we developed a stochastic model to simulate a cohort of severe allergic asthma patients, using demographic and clinical data from ProAr Brazilian cohort of asthma patients (≥ 18 years old). A patient cohort was simulated and sampling considering the following characteristics: sex, body weight and IgE level. For each 5,000 simulation, we estimated treatment costs with both immunobiologic agents. Costs were assumed according to the Brazilian private healthcare perspective. Reference price (per vial) was USD782.75 for dupilumab 200mg/300mg and USD227.38 for omalizumab 75mg (USD454.77 for 150mg); drug administration cost was USD19.22 based on local database (D-TISS). Reference costs were from 31 August 2021, with USD1.00 equivalent to BRL5.1427.

RESULTS: The simulated cohort resulted in, 81.3% female patients, mean body weight of 75.1kg, mean IgE level of 532IU/mL and 16.6% of non-eligible patients for omalizumab due to their body weight and serum IgE level combination, according to label dosing restrictions. Annual cost of dupilumab was USD21,725 for the first year and USD20,923 for subsequent years per patient. Average annual cost of omalizumab was USD21,542, per patient, regarding a mean dose of 537mg (SD 285) over a four-week period. Annual cost of omalizumab ranged from USD6,183 to USD47,960 per patient.

CONCLUSIONS: We observed similar average treatment costs with dupilumab and omalizumab in the simulated population. However, while cost of dupilumab treatment is fixed for patients with severe allergic asthma allowing more resource use predictability, costs of omalizumab treatment are highly variable depending on patient characteristics. These findings should be considered by policy makers for decisions regarding coverage/reimbursement and clinical protocols development.