Cost‐effectiveness analysis comparing dupilumab and aspirin desensitization therapy for chronic rhinosinusitis with nasal polyposis in aspirin‐exacerbated respiratory disease
Autor: | Evan Walgama, Jeromie Ballreich, Michael Yong, Andrew Thamboo, Yu Qi Wu, Joel Howlett |
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Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Cost-Benefit Analysis medicine.medical_treatment Salvage therapy Antibodies Monoclonal Humanized Nasal Polyps Quality of life Internal medicine Humans Immunology and Allergy Medicine health care economics and organizations Rhinitis Desensitization (medicine) Cost–utility analysis Aspirin Acetylsalicyclic acid business.industry Cost-effectiveness analysis Dupilumab Otorhinolaryngology Desensitization Immunologic Chronic Disease Quality of Life business medicine.drug |
Zdroj: | International Forum of Allergy & Rhinology. 11:1626-1636 |
ISSN: | 2042-6984 2042-6976 |
Popis: | Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) in the setting of aspirin-exacerbated respiratory disease (AERD) is a disease that is difficult to treat and prone to recurrence. Dupilumab is a promising treatment for these patients, but its cost-effectiveness has not yet been compared with aspirin (acetylsalicyclic acid, or ASA) desensitization, a known and effective treatment. We aimed to compare the cost-effectiveness of ASA desensitization with dupilumab therapy for the treatment of CRSwNP in AERD. Methods Analyses of cost-effectiveness, as measured in quality-adjusted life years (QALYs), and cost-utility, as measured in number of required revision endoscopic sinus surgeries (ESSs), were conducted. Results ASA desensitization after ESS was cost-effective and dominated appropriate medical management. Adding salvage dupilumab was also cost-effective (incremental cost-effectiveness ratio [ICER] $135,517.33), and upfront dupilumab therapy was not cost-effective in any scenario (ICER $273,181.32). The cost-utility analysis demonstrated that, over a 10-year period per patient, appropriate medical management after ESS cost $54,125.31 and resulted in 2.25 revision ESSs, ASA desensitization after ESS cost $53,775.15 and resulted in 2.02 revision ESSs, ASA desensitization with salvage dupilumab cost $121,176.25 and resulted in 1.68 revision ESSs, and upfront dupilumab cost $185,950.34 and resulted in 1.51 revision ESSs. Conclusion Dupilumab for the treatment of severe CRSwNP was found to be cost-effective as salvage therapy under the willingness-to-pay threshold of $150,000. Further analysis highlighted that the cost-effectiveness of dupilumab was most sensitive to drug price and expected gains in quality of life. This suggests that additional investigation into improving patient population selection and tailoring treatment algorithms may improve the cost-effectiveness of dupilumab in specific scenarios. |
Databáze: | OpenAIRE |
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