OBJECTIVES: For many years, asthma symptoms have been treated with corticosteroids and bronchodilators. For patients with the severe, type 2 phenotype of asthma in which there is an increase in T helper cells, new monoclonal antibody therapies have been developed to target the inflammatory signaling pathways. Health technology assessments (HTAs) attempt to balance these agents’ clinical benefit alongside increased expense. The objective of this analysis was to evaluate recent HTA decisions, and their rationales, for asthma therapies to identify trends in selected countries.

METHODS: HTA surveillance was conducted for Australia, Canada, France, Germany, and the United Kingdom (UK) from January 1, 2012 to June 1, 2018 (78 months). HTAs for asthma therapies were evaluated by indication, drug class, decision, and rationale for the decision. Decisions were categorized as favorable, unfavorable, or mixed (both favorable and unfavorable).

RESULTS: There were 26 HTA decisions for 15 unique asthma treatments published during the study period. Across the studied countries, 16 (62%) decisions were favorable, 5 (19%) were unfavorable, and 5 (19%) were mixed. While many favorable decisions included restrictions to define the reimbursed place in therapy, the mixed decisions also required significant pricing discounts for access. When comparing the first 39 months (1/1/2012 – 3/31/2015) to the most recent 39 months (4/1/2015 – 6/01/2018) of the study period, there was a decrease in the number of favorable decisions (82% vs 47%), and uniform increases in the number of mixed and unfavorable decisions (both 9% vs 27% respectively).

CONCLUSIONS: Recent trends show increasing proportions of mixed and unfavorable asthma-related HTA decisions. Agencies are placing greater access restrictions to more narrowly define treatment eligible populations and more frequently making reimbursement dependent on improved cost-effectiveness. These results demonstrate the importance of strong clinical and pharmacoeconomic evidence to achieve access for asthma therapies.