Asthma biologics show steep rise in use and cost

Doubling of total cost of care with only a small decrease in hospitalization and ER visits.

August 21, 2020

Total cost of care study charts questionable asthma biologic value and rise as a new expensive drug class to treat severe asthma; Use and cost of asthma biologics has nearly doubled over 2.5 years, delivering a substantial increase in total cost of care, poor persistence, and only a small decrease in hospitalization and ER visits.

Asthma affects approximately 25 million Americans and has an estimated societal cost of $56 billion. Severe asthma represents 5–10% of asthma patients, but accounts for almost 50% of all asthma costs.¹² Guidelines now recommend an asthma biologic for severe asthma,³ but little real world data is available on the use of asthma biologics and their impact on cost of care.

This study looked at the five asthma biologics: Cinqair® (reslizumab); Dupixent® (dupilumab); Fasenra® (benralizumab); Nucala® (mepolizumab), and Xolair® (omalizumab), in use by patients with severe asthma. Because some of the asthma biologics are infused and medical benefit billed while others are self-administered and billed on pharmacy benefit, it is only through integrated medical and pharmacy benefit insurance coverage and analytics can a comprehensive asthma biologic assessment be done. This integrated assessment of 15 million commercially insured lives found, asthma biologic drug utilization was up 78% over 2.5 years resulting in drug costs up 85% over same time frame.

All five asthma biologics exceed commonly accepted thresholds for cost-effectiveness.4

Across Prime’s commercial population, 1,492 members fit the study criteria and were defined as new starts for the asthma biologics. Study time frame was July 2017 to June 2019. For each asthma biologic, the study measured persistence after three months and after six months, pre study period and post study period asthma ER/hospitalization events and pre and post study period cost of care.

This assessment found a substantial increase in total cost of care, poor persistence, and a small decrease in hospitalization/ER visits after therapy initiation. Prime’s advanced analytics maximizes the use of the integrated data, providing data-specific outcomes. These results provide evidence for insurers to consider implementing value-based pharmaceutical manufacturer purchasing agreements to ensure fair pricing to value, and clinical programs to improve persistence.


References

  1. Centers for Disease Control and Prevention. National Center for Health Statistics Faststats. 2017; https://www.cdc.gov/nchs/fastats/asthma.htm. Accessed October 2019.
  2. Centers for Disease Control and Prevention. ASTHMA FACTS – CDC’s National Asthma Control Program Grantees. 2013; https://www.cdc.gov/asthma/pdfs/asthma_facts_program_grantees.pdf. Accessed October 2019.
  3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2019. Available from: www.ginasthma.org/.
  4. Institute for Clinical and Economic Review. Biologic therapies for treatment of asthma associated with type 2 inflammation: effectiveness, value, and value-based price benchmarks. Final Evidence Report. December 20, 2018
New Initiators to Asthma Biologics: A Pre/Post Analysis of Utilization Patterns, Total Cost of Care, and Asthma-related Events Among 14 Million Commercially Insured Members (Spring 2020)

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