OBJECTIVES : This study was developed to identify criteria for prioritizing treatments for severe asthma in adult patients and to apply the developed framework on existing treatment alternatives, under the Brazilian private healthcare system perspective.

METHODS : A literature review was developed to identify criteria for technology prioritization in the context of interest. These were validated with representatives of patient associations groups (PAGs), medical specialists and private healthcare managers (PHMs). Three representatives of each group were invited to participate in a MCDA panel to elicit weights for the validated criteria, using the swing weighting methodology. Treatment alternatives included in the analysis were benralizumab, mepolizumab, omalizumab and “no treatment with immunobiologic” (standard treatment with CI+LABA). To assess treatments’ performance in the selected criteria, data were extracted from published literature and reference cost lists.

RESULTS : The criteria included in the MCDA were efficacy, patient reported outcomes (PROs), safety, convenience and costs. Sub-criteria for efficacy (reduction in asthma exacerbations in general and requiring hospital care, variation in prebronchodilator forced expiratory volume in 1 second, and reduction in oral corticosteroid dose), PROs (control of symptoms and quality of life) and convenience (frequency of infusions and fixed/variable dose) were also included. Efficacy was the top ranked criteria for all stakeholder groups, followed by PROs (for PAGs and medical specialists) or by safety (for PHM). For PAGs and medical specialists, the top ranked alternative was benralizumabe. For PHM, the top ranked alternatives were benralizumab and “no treatment”, with the same final score. The subsequent ranking order was mepolizumab, omalizumab and “no treatment” to medical specialists; mepolizumab, “no treatment” and omalizumab do PAGs; mepolizumab and omalizumab to PHM.

CONCLUSIONS : When compared to other biologics registered in Brazil for maintenance treatment of severe asthma in adult patients, benralizumab scored higher as a preferential treatment for all stakeholder groups included in the MCDA.