SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
9/8/04
Cost of asthma control with anti-IgE therapy
Summary
Background - Recent studies have shown that treatment of asthma with omalizumab (Omal), a monoclonal anti-IgE antibody, can reduce the frequency of hospitalizations and Emergency Department (ED) visits for acute asthma episodes. However, such Omal therapy is quite expensive ($10,000 - $12,000/year). Is Omal therapy cost effective for all asthmatics?
Findings - Oba and Salzman carried out a retrospective analysis of Omal therapy using data collected over a 52-week period in two randomized, placebo-controlled clinical trials of Omal treatment in adolescents and adults with moderate/severe asthma. They found, as expected, a significant reduction in the frequency of hospitalization and ED visits in the Omal treated patients. However, the cost of Omal treatment to achieve each additional day of well-controlled asthma in this group was $523.
Conclusions - Omal therapy would be better used in allergic asthmatics poorly controlled despite maximal therapy (excluding oral steroids). Omal treatment could be cost saving if given to non-smoking asthmatics who have been hospitalized at least 5 times (or > 20 days) in the previous year despite maximal therapy.
Reference
J Allergy Clin Immunol 2004; 114:265-69
Editor's Comments
My personal impression from hearing presentations and reading reports about Omal clinical trials in asthma is that Omal does exert some beneficial effects in moderate to severe allergic asthma not well controlled on inhaled corticosteroid therapy. However, the substantial current cost of Omal treatment makes it cost-effective at present for only those asthmatics of a degree of severity leading to frequent emergency treatments and hospitalizations. Omal therapy is also appropriate in only those asthmatics with a significant allergic component and serum IgE levels within a certain range.
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