The Cost-Effectiveness of Omalizumab for Treatment of Food Allergy.

Autor:	Shaker M; Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Depatments of Pediatrics and Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH. Electronic address: marcus.shaker@dartmouth.edu., Anagnostou A; Department of Allergy and Immunology, Texas Children's Hospital, Houston, Texas., Abrams EM; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada., Lee M; Department of Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH., Conway AE; Depatments of Pediatrics and Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH., Hsu Blatman KS; Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Depatments of Pediatrics and Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH., Oppenheimer J; UMDNJ Rutgers University School of Medicine, Newark, NJ., Greenhawt M; Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2024 Sep; Vol. 12 (9), pp. 2481-2489.e1. Date of Electronic Publication: 2024 Jun 25.
DOI:	10.1016/j.jaip.2024.06.023
Abstrakt:	Background: Omalizumab is an anti-IgE therapy newly approved by the Food and Drug Administration for allergen agnostic treatment of single or multiple food allergies in patients aged 1 year or older. Objective: Evaluate the cost-effectiveness of omalizumab as a food allergy treatment. Methods: We evaluated health and economic outcomes in Markov cohorts of simulated food allergic infants randomized to receive omalizumab using a 15-year horizon. Monte Carlo simulation was used (n = 40,000 subjects) to evaluate cost-effectiveness from a societal perspective, incorporating both a family-level and individual-level analysis. We included family-level analysis to incorporate a broad perspective for health utility change, given treatment effects likely benefit all parties at home (eg, caregivers, siblings), not just the patient, representing the sum of changes in all such persons. Supplemental analyses explored lower omalizumab cost and home initiation. We performed deterministic and probabilistic sensitivity analyses. Results: In the family-level cohort analysis, omalizumab exceeded cost-effectiveness thresholds ($185,183/quality-adjusted life-years [QALY]). In a comparison of the omalizumab strategy (OMA) with the non-omalizumab strategy, the cost of OMA exceeded the non-omalizumab strategy ($315,020 vs $136,609) with greater incremental effectiveness (12.668 vs 11.699 QALY). In the individual-level analysis, the cost-effectiveness of OMA was $573,698/QALY. In base-case assessments, OMA was cost-effective (willingness to pay, $100,000/QALY) at a health state utility (HSU) improvement of 0.265. The value-based cost of OMA ranged from $14,166 to $23,791 when it was considered at the individual and family-unit levels. Requiring OMA administration in the clinic was not cost-effective (incremental cost-effectiveness ratio, $260,239). Conclusions: In the base case and at current pricing, omalizumab is not cost-effective, but it could be at a lower retail price or when use creates large health utility shifts in the family and patient. (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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