Cost Effectiveness Of Bronchial Thermoplasty For Treatment Of Severe Asthma Patients In Scotland

Objectives: Bronchial thermoplasty (BT) is a technology that reduces airway smooth muscle mass and airway hyper-reactivity; 5-year outcome data has demonstrated a durable reduction in exacerbations after BT treatment compared to standard of care. This analysis aimed to assess the cost–effectiveness of BT for asthma in Spain. Methods: A Markov model was adapted comparing BT to high-dose combination therapy among poorly controlled, severe persistent asthma patients. Costs of BT, asthma exacerbations, and maintenance medications were estimated from country-specific pricing. Clinical efficacy and health utilities were estimated from the double-blind AIR2 trial. The models assessed patients for 5 years; incremental cost-effectiveness ratios (ICERs) are reported. Results: BT decreased asthma exacerbations and increased QALYs. The QALY improvement with BT was 0.2760. Incremental costs of BT were €5,167, driven primary by savings produced from averted asthma exacerbations. The incremental cost effectiveness ratio for BT compared to standard of care was €18,720/QALY –considered to be favorable within the region. Results were most sensitive to baseline probabilities of exacerbation, utilities and time horizon considered. Conclusions: Compared with standard of care, BT reduced asthma exacerbations, improved health outcomes, and reduced healthcare utilization related to exacerbations among poorly controlled, severe persistent asthma patients. As additional studies investigate BT’s longer-term impact, the economic impact of this novel technology will be further demonstrated. Our findings suggest that BT should be considered an efficacious treatment for this difficult-to-treat patient population.