对重度嗜酸性粒细胞性哮喘患者使用mepolizumab：III期MENSA试验的经济学分析
2017/10/09
摘要
背景：重度嗜酸性粒细胞性哮喘病人具有较高的急性加重风险，而哮喘的急性加重导致医疗费用花费巨大。Mepolizumab能降低嗜酸性粒细胞水平并降低重度嗜酸性粒细胞性哮喘急性加重的发生风险。我们评估，相对于安慰剂，mepolizumab治疗对哮喘相关急性加重花费的影响。
方法：在予以重度哮喘患者mepolizumab辅助治疗(MENSA)的试验内进行经济学分析。以下项目用于量化增量：(1)哮喘相关急性加重的医疗费用(2) 哮喘相关急性加重的急诊科门诊或住院费用(3) 哮喘相关总的医疗保健资源使用。
结果：哮喘相关急性加重的8个月平均医疗费用在75mg mepolizumab静脉注射(IV)组，100mg mepolizumab皮下注射(SC)组和安慰剂组中分别为969, 852和1692美元(p = 0.16)。由哮喘相关急性加重所导致的急诊科门诊或住院的平均医疗费用在75mg mepolizumab IV组，100mg mepolizumab SC组和安慰剂组中分别为901, 795, and 1557美元(p = 0.020)。相对于安慰剂组，mepolizumab组的哮喘相关医疗保健资源使用（所有服务）更低。
结论:在标准重度嗜酸性粒细胞性哮喘治疗的基础上加入mepolizumab能降低哮喘急性加重相关的医疗费用和医疗保健资源使用。尽管所节约的费用约为每人723-840美元，但差异没有统计学意义。
Economic analysis of the phase III MENSA study evaluating mepolizumab for severe asthma with eosinophilic phenotype.
Basu A, Dalal A, Canonica GW, Forshag M, Yancey SW, Nagar S, Bell CF.
Abstract
BACKGROUND:Severe eosinophilic asthma patients are at risk of exacerbations, which are associated with substantial costs. Mepolizumab lowers eosinophil levels and reduces exacerbation risk in severe eosinophilic asthma. We evaluated asthma-related exacerbation costs in mepolizumab-treated patients (versus placebo).
METHODS:A within-trial economic analysis of the Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma (MENSA) trial. Objectives were to quantify the incremental: (1) medical costs of asthma-related exacerbation; (2) asthma-related exacerbation emergency department visit/hospitalization costs; and (3) asthma-related total healthcare resource utilization.
RESULTS:Mean medical costs of asthma-related exacerbations at 8 months were $969, $852, and $1692 in the mepolizumab 75 mg intravenous (IV), mepolizumab 100 mg subcutaneous (SC), and placebo groups, respectively (p = 0.16). Mean medical costs from emergency department visits or hospitalizations due to asthma-related exacerbations were $901, $795, and $1557 in the mepolizumab 75 mg IV, mepolizumab 100 mg SC, and placebo groups (p = 0.020). Asthma-related healthcare resource utilization (all services) was lower for the mepolizumab groups versus placebo.
CONCLUSIONS:Adding mepolizumab to standard-of-care treatment for severe eosinophilic asthma lowered asthma exacerbation-related medical costs/healthcare resource utilization; although the cost savings ranged from $723-$840 per patient, differences were not statistically significant.
背景：重度嗜酸性粒细胞性哮喘病人具有较高的急性加重风险，而哮喘的急性加重导致医疗费用花费巨大。Mepolizumab能降低嗜酸性粒细胞水平并降低重度嗜酸性粒细胞性哮喘急性加重的发生风险。我们评估，相对于安慰剂，mepolizumab治疗对哮喘相关急性加重花费的影响。
方法：在予以重度哮喘患者mepolizumab辅助治疗(MENSA)的试验内进行经济学分析。以下项目用于量化增量：(1)哮喘相关急性加重的医疗费用(2) 哮喘相关急性加重的急诊科门诊或住院费用(3) 哮喘相关总的医疗保健资源使用。
结果：哮喘相关急性加重的8个月平均医疗费用在75mg mepolizumab静脉注射(IV)组，100mg mepolizumab皮下注射(SC)组和安慰剂组中分别为969, 852和1692美元(p = 0.16)。由哮喘相关急性加重所导致的急诊科门诊或住院的平均医疗费用在75mg mepolizumab IV组，100mg mepolizumab SC组和安慰剂组中分别为901, 795, and 1557美元(p = 0.020)。相对于安慰剂组，mepolizumab组的哮喘相关医疗保健资源使用（所有服务）更低。
结论:在标准重度嗜酸性粒细胞性哮喘治疗的基础上加入mepolizumab能降低哮喘急性加重相关的医疗费用和医疗保健资源使用。尽管所节约的费用约为每人723-840美元，但差异没有统计学意义。
（复旦大学附属中山医院呼吸内科 胡湘麟 摘译 杨 冬 审校）
（Expert Rev Pharmacoecon Outcomes Res. 2017;17(2):121-131.）
（Expert Rev Pharmacoecon Outcomes Res. 2017;17(2):121-131.）
Economic analysis of the phase III MENSA study evaluating mepolizumab for severe asthma with eosinophilic phenotype.
Basu A, Dalal A, Canonica GW, Forshag M, Yancey SW, Nagar S, Bell CF.
Abstract
BACKGROUND:Severe eosinophilic asthma patients are at risk of exacerbations, which are associated with substantial costs. Mepolizumab lowers eosinophil levels and reduces exacerbation risk in severe eosinophilic asthma. We evaluated asthma-related exacerbation costs in mepolizumab-treated patients (versus placebo).
METHODS:A within-trial economic analysis of the Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma (MENSA) trial. Objectives were to quantify the incremental: (1) medical costs of asthma-related exacerbation; (2) asthma-related exacerbation emergency department visit/hospitalization costs; and (3) asthma-related total healthcare resource utilization.
RESULTS:Mean medical costs of asthma-related exacerbations at 8 months were $969, $852, and $1692 in the mepolizumab 75 mg intravenous (IV), mepolizumab 100 mg subcutaneous (SC), and placebo groups, respectively (p = 0.16). Mean medical costs from emergency department visits or hospitalizations due to asthma-related exacerbations were $901, $795, and $1557 in the mepolizumab 75 mg IV, mepolizumab 100 mg SC, and placebo groups (p = 0.020). Asthma-related healthcare resource utilization (all services) was lower for the mepolizumab groups versus placebo.
CONCLUSIONS:Adding mepolizumab to standard-of-care treatment for severe eosinophilic asthma lowered asthma exacerbation-related medical costs/healthcare resource utilization; although the cost savings ranged from $723-$840 per patient, differences were not statistically significant.
