Objective: We determined the cost-effectiveness as well as the budgetary impact of benralizumab plus high dosages of inhaled corticosteroids plus long-acting β₂-agonists (ICS-LABA) compared with omalizumab plus ICS-LABA for the treatment of adults with severe uncontrolled eosinophilic asthma.

Methods: A cost-effectiveness analysis (CEA) was undertaken from the perspective of the Mexican public health system. A matching-adjusted indirect comparison was performed considering SIROCCO and CALIMA trials for benralizumab, INNOVATE and EXTRA for omalizumab. A three-state Markov model was conducted: no exacerbation, exacerbation and death, with cycles of 4 weeks. Before entering to Markov process, patients were classified according to their oral corticosteroid use and levels of response after a pre-established period (8 weeks for benralizumab and 16 weeks for omalizumab). Patients with no acceptable response remain only with maintenance treatment (ICS-LABA), while responders continue receiving biological add-on treatment. The outcome measure was exacerbations frequency. Direct medical costs were assessed. A lifetime horizon was used with a discount rate of 5%. Sensitivity analyzes and a budget impact analysis (BIA) were conducted.

Results: Biologics plus ICS-LABA suggested a cumulative frequency of exacerbations per patient of 20.34 for benralizumab and 22.53 for omalizumab. Benralizumab plus ICS-LABA was more cost-effective than omalizumab plus ICS-LABA with MXN$68,087 less cost for exacerbation avoided. In addition, BIA demonstrates the small increase of benralizumab (0.016%) on the budget that Mexican public health system allocates for medicines and pharmaceutical products. Sensitivity analyses suggest that the conclusions of the base case are robust.

Conclusions: Using model input from the Mexican public health system, benralizumab as add-on to maintenance treatment for uncontrolled, severe eosinophilic asthma decreased the occurrence and costs of clinically relevant exacerbations. Benralizumab demonstrated its cost-effectiveness and reduced budgetary impact against omalizumab on the Mexican public health sector.