OBJECTIVES: Evaluate the cost-effectiveness of dupilumab vs other biologics for the treatment of adult patients with severe asthma in Colombia from the healthcare system perspective.

METHODS: A cost-effectiveness analysis was developed including only direct medical costs comparing dupilumab 200mg versus mepolizumab 100mg, benralizumab 30mg and omalizumab 300mg, 450mg and 600mg dosing as add-on therapy to the standard of care.

A Markov based model was used to estimate the costs and QALYs associated with the use of biologics and exacerbation management for alternatives over a 5-year horizon period.

Clinical data for responses, transition probabilities, exacerbations rates and discontinuation rates for the alternatives were obtained from published literature. Utility values for health states and events were taken from QUEST study post-hoc analysis.

Costs included treatment acquisition, treatment administration and use of healthcare resources for exacerbation events management. Sources were taken from national public databases and published literature.

One-way and probabilistic sensitivity analysis was performed for clinical and cost input parameters.

RESULTS: Dupilumab 200mg versus mepolizumab 100mg, benralizumab 30mg and omalizumab 450mg and 600mg, has greater QALYs, lower costs and a resulting ICER of -$20,304 USD, -$123,849 USD, -$582,149 USD, and -$3,773,825 USD respectively. Against omalizumab 300mg, dupilumab has greater QALYs and costs, with an ICER of $1,013,689, above the Willingness-to-pay threshold of 3x GDP per capita (~16,500 USD). Sensitivity analysis are consistent with base case results.

CONCLUSIONS: Dupilumab 200mg is cost-effective against mepolizumab 100mg, benralizumab 30mg and omalizumab 450mg and 600mg. Compared to omalizumab 300mg, dupilumab is deemed as not cost-effective.

Dupilumab 200mg can be expected to be cost-effective when it is globally compared to omalizumab, since the average dose for a usual cohort is 450mg or above.

This analysis based on indirect comparisons is useful for decision making process to choose biologic therapies for the treatment of patients with severe asthma.