临床与家庭使用奥马利珠单抗和美泊利单抗的健康和经济效益评估对比
2019/11/12
摘要
背景：生物治疗是许多哮喘和慢性荨麻疹患者的一种范式转换管理策略，但对治疗相关的过敏反应的关注可能会限制那些无法前往医疗诊所的患者使用这些疗法。
目的：比较奥马利珠单抗和美泊利单抗的临床和家庭生物治疗的成本效益。
方法：对哮喘或慢性自发性荨麻疹患者在过敏门诊、初级保健提供者（PCP）办公室或者家内接受奥马利珠单抗或美泊利单抗治疗的一年时间范围内（每病例每年12次注射，敏感性分析为每年24次注射），从社会和医疗保健部门的角度进行微观模拟经济评价。于新英格兰北部三级护理变态反应诊所接受奥马珠单抗或美泊利单抗的的患者同时将路途时间和距离纳入分析，最大支付意愿（WTP）1000万美元用于预防死亡，临床用药减少过敏性病死率、住院率10～100倍。进行确定性和概率敏感性分析。
结果：过敏门诊单程路途距离明显超过当地PCP办公室（49英里，95%CI 42-56 vs 12英里，95%CI 10-15）。在应用奥马珠单抗的社会分析中，每年的PCP和过敏门诊治疗费用分别为1369.14美元（SD，51.33美元）和1916.68美元（SD，40.86美元）。临床用药导致的与药物有关的死亡率的小幅度下降被前往过敏门诊导致的车祸死亡率的潜在增加所抵消（该策略为每百万人年1460人，SD 15.0）。与家庭管理相比，临床奥马利珠单抗管理并不划算，增量成本效益比（ICER）为500648430美元（PCP），过敏诊所管理以较高的成本和与汽车相关的死亡率为主。除非过敏反应发生率或自我管理教学成本高，美泊利单抗使用的常规管理主要为家庭管理。
结论：对许多患者来说，在家中使用奥马利珠单抗或美泊利单抗可能是一种成本效益高的策略。
Estimation of Health and Economic Benefits of Clinic Versus Home Administration of Omalizumab and Mepolizumab.
Shaker M, Briggs A, Dbouk A, Dutille E, Oppenheimer J, Greenhawt M.
Abstract
BACKGROUND: Biologic therapy is a paradigm-shifting management strategy for many patients with asthma and chronic urticaria, but concerns for therapy-associated anaphylaxis may limit access to these therapies for patients unable to travel to medical clinics.
OBJECTIVE: To characterize the cost-effectiveness of in-clinic vs. at-home biologic therapy with omalizumab and mepolizumab.
METHODS: Economic evaluation using microsimulations was performed from societal and healthcare sector perspectives for patients with asthma or chronic spontaneous urticaria receiving omalizumab or mepolizumab in an Allergy clinic, primary care provider (PCP) office, or at home over a 1-year time horizon (12 injections per year in each base-case with sensitivity analysis to 24 injections per year). Travel times and distances were applied to a population attending a tertiary-care allergy clinic in Northern New England receiving omalizumab or mepolizumab, using a Willingness to Pay (WTP) of $10 million per death-prevented and in-clinic administration reducing anaphylaxis fatality and hospitalization 10-to-100-fold. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: One-way Allergy clinic travel distances significantly exceeded local PCP offices (49 miles, 95% CI 42-56, vs. 12 miles, 95% CI 10-15). In the omalizumab societal analysis, annual PCP and Allergy clinic administration cost $1,369.14 (SD, $51.33) and $1,916.68 (SD, $40.86), respectively. Small reductions in medication-related fatalities with in-clinic administration were offset by the potential increase in automobile fatalities resulting from traveling to the Allergy clinic (14.6 per million person-years for this strategy, SD 15.0). Compared to at-home administration, in-clinic omalizumab administration was not cost-effective, with an incremental cost-effectiveness ratio (ICER) of $500,648,430 (PCP), and with Allergy clinic administration dominated by higher costs and automobile-related fatalities. Routine mepolizumab clinic administration was dominated by at-home administration unless anaphylaxis rates or self-administration teaching costs were high.
CONCLUSIONS: For many patients, at-home administration of omalizumab or mepolizumab may be a cost-effective strategy.
背景：生物治疗是许多哮喘和慢性荨麻疹患者的一种范式转换管理策略，但对治疗相关的过敏反应的关注可能会限制那些无法前往医疗诊所的患者使用这些疗法。
目的：比较奥马利珠单抗和美泊利单抗的临床和家庭生物治疗的成本效益。
方法：对哮喘或慢性自发性荨麻疹患者在过敏门诊、初级保健提供者（PCP）办公室或者家内接受奥马利珠单抗或美泊利单抗治疗的一年时间范围内（每病例每年12次注射，敏感性分析为每年24次注射），从社会和医疗保健部门的角度进行微观模拟经济评价。于新英格兰北部三级护理变态反应诊所接受奥马珠单抗或美泊利单抗的的患者同时将路途时间和距离纳入分析，最大支付意愿（WTP）1000万美元用于预防死亡，临床用药减少过敏性病死率、住院率10～100倍。进行确定性和概率敏感性分析。
结果：过敏门诊单程路途距离明显超过当地PCP办公室（49英里，95%CI 42-56 vs 12英里，95%CI 10-15）。在应用奥马珠单抗的社会分析中，每年的PCP和过敏门诊治疗费用分别为1369.14美元（SD，51.33美元）和1916.68美元（SD，40.86美元）。临床用药导致的与药物有关的死亡率的小幅度下降被前往过敏门诊导致的车祸死亡率的潜在增加所抵消（该策略为每百万人年1460人，SD 15.0）。与家庭管理相比，临床奥马利珠单抗管理并不划算，增量成本效益比（ICER）为500648430美元（PCP），过敏诊所管理以较高的成本和与汽车相关的死亡率为主。除非过敏反应发生率或自我管理教学成本高，美泊利单抗使用的常规管理主要为家庭管理。
结论：对许多患者来说，在家中使用奥马利珠单抗或美泊利单抗可能是一种成本效益高的策略。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2019 Oct 15. pii: S2213-2198(19)30866-9. doi: 10.1016/j.jaip.2019.09.037.)
(J Allergy Clin Immunol Pract. 2019 Oct 15. pii: S2213-2198(19)30866-9. doi: 10.1016/j.jaip.2019.09.037.)
Estimation of Health and Economic Benefits of Clinic Versus Home Administration of Omalizumab and Mepolizumab.
Shaker M, Briggs A, Dbouk A, Dutille E, Oppenheimer J, Greenhawt M.
Abstract
BACKGROUND: Biologic therapy is a paradigm-shifting management strategy for many patients with asthma and chronic urticaria, but concerns for therapy-associated anaphylaxis may limit access to these therapies for patients unable to travel to medical clinics.
OBJECTIVE: To characterize the cost-effectiveness of in-clinic vs. at-home biologic therapy with omalizumab and mepolizumab.
METHODS: Economic evaluation using microsimulations was performed from societal and healthcare sector perspectives for patients with asthma or chronic spontaneous urticaria receiving omalizumab or mepolizumab in an Allergy clinic, primary care provider (PCP) office, or at home over a 1-year time horizon (12 injections per year in each base-case with sensitivity analysis to 24 injections per year). Travel times and distances were applied to a population attending a tertiary-care allergy clinic in Northern New England receiving omalizumab or mepolizumab, using a Willingness to Pay (WTP) of $10 million per death-prevented and in-clinic administration reducing anaphylaxis fatality and hospitalization 10-to-100-fold. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: One-way Allergy clinic travel distances significantly exceeded local PCP offices (49 miles, 95% CI 42-56, vs. 12 miles, 95% CI 10-15). In the omalizumab societal analysis, annual PCP and Allergy clinic administration cost $1,369.14 (SD, $51.33) and $1,916.68 (SD, $40.86), respectively. Small reductions in medication-related fatalities with in-clinic administration were offset by the potential increase in automobile fatalities resulting from traveling to the Allergy clinic (14.6 per million person-years for this strategy, SD 15.0). Compared to at-home administration, in-clinic omalizumab administration was not cost-effective, with an incremental cost-effectiveness ratio (ICER) of $500,648,430 (PCP), and with Allergy clinic administration dominated by higher costs and automobile-related fatalities. Routine mepolizumab clinic administration was dominated by at-home administration unless anaphylaxis rates or self-administration teaching costs were high.
CONCLUSIONS: For many patients, at-home administration of omalizumab or mepolizumab may be a cost-effective strategy.
