Procedures: Procedures 1 - EMN/BT/Rigid/Cryo |

Bronchial Thermoplasty vs Omalizumab for Severe Uncontrolled Asthma: Relative Efficacy and Chronicity of Costs of Care FREE TO VIEW

Michael Wechsler, MD; Michael Cangelosi, MPH; Michael Simmonds; Narinder Shargill, PhD; Dominic Tilden, MPH; Suzi Cottrell, PhD; Robert Niven, MD
Author and Funding Information

National Jewish Health, Denver, CO

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1011A. doi:10.1016/j.chest.2016.08.1117
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SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Bronchial Thermoplasty (BT) is a one-time treatment recommended as a GINA Step 5 add-on treatment for severe uncontrolled asthma. Omalizumab (OM) is similarly recommended as a GINA Step 5 add-on treatment for uncontrolled asthma and these two treatments may be evaluated by clinicians as alternatives to one another. In the midst of discussions within the US regarding high drug costs for monoclonal antibody therapies, clinicians may consider the acute costs of a procedural treatment a reasonable alternative. However, no clinical trials have directly compared BT and OM to afford clinicians the ability to compare relative clinical efficacy as well as costs. Thus, an indirect treatment comparison (ITC) is presented using optimized asthma therapy (OAT) as a common control. ITCs are often utilised in health technology assessment to establish comparative effectiveness in the absence of direct trial evidence. We extend these results with a three year simulation of costs of care delivered and differences in asthma-related healthcare utilization.

METHODS: The ITC comprises a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA), identified in a systematic literature review, and uses Bucher’s method. Costs of care over a three year period were based on payments and discounted at 3.5% annually over a three year period; differences in rates of asthma-related healthcare utilization were leveraged from the ITC within this cost simulation.

RESULTS: Comparing the post-treatment period with BT to ongoing treatment with OM, there were no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM via OAT 0.92, p=0.67) or hospitalisations (RR 0.68; p=0.63). The rate of emergency department (ED) visits was reduced by 75% with BT versus OM and was statistically significant (RR 0.25, p=0.01). Improvements in patients’ quality of life (response on asthma quality of life questionnaire - AQLQ) were comparable (RR 1.06; p=0.59). Simulated costing analysis suggest cost-savings on the order of $6,000 USD in the first year, and additional savings thereafter.

CONCLUSIONS: BT compares favourably to potentially more-costly pharmaceutical therapies for asthma. We observe a significant decrease in asthma-related ER events. Due to potential differences of the trial populations and the indirect comparison, the analyses should be interpreted with some caution and is provided for educational purposes.

CLINICAL IMPLICATIONS: Clinicians evaluating these two add-on treatments should consider the totality of evidence as well as patient preferences to make an informed decision. US clinicians concerned about the high chronic costs of OM for severe uncontrolled asthma may consider BT as a means to potentially defray these costs without sacrificing significant efficacy.

DISCLOSURE: Michael Cangelosi: Employee: Boston Scientific, Shareholder: Boston Scientific Michael Simmonds: Employee: Boston Scientific Narinder Shargill: Employee: Boston Scientific, Shareholder: Boston Scientific Dominic Tilden: Consultant fee, speaker bureau, advisory committee, etc.: Boston Scientific Suzi Cottrell: Consultant fee, speaker bureau, advisory committee, etc.: Boston Scientific The following authors have nothing to disclose: Michael Wechsler, Robert Niven

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