Mepolizumab reduces asthma exacerbations, expenditures in patients with history of high cost
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Among patients with severe asthma and the highest expenditures prior to treatment, mepolizumab reduced asthma exacerbations, oral corticosteroid use and related costs, according to research presented at the CHEST Annual Meeting.
“Of all the patients with asthma, those with severe asthma use the majority of health care resources and account for most of the spending,” Njira Lucia Lugogo, MD, clinical associate professor at the University of Michigan Ann Arbor, said during a presentation. “Improving the health outcomes of this group could have a disproportionately large effect on reducing costs within the health care system.”
Lugogo and colleagues conducted a retrospective study to evaluate the impact of mepolizumab (Nucala, GlaxoSmithKline) on asthma exacerbations, use of oral corticosteroids (OCS) and asthma-related health care costs in a subset of patients defined as “high cost” in the year before initiating treatment. The study included 281 patients in the U.S. with severe asthma (mean age, 53.9 years; 59% women) and commercial or Medicare Advantage insurance who received mepolizumab from November 2015 to December 2018.
Patients with a history of “high cost” included those with total health care expenditures in the 80th percentile or higher and comorbidities consistent with high cost according to the Deyo-Charlson Comorbidity Index (DCI score 3).
Comparing 12 months before and after treatment, researchers observed a 40% reduction in the rate of asthma exacerbations (2.5 vs. 1.5; P < .001) and a 50% reduction in the mean rate of exacerbations requiring hospitalization (0.2 vs. 0.1; P < .001) with mepolizumab treatment, according to the results.
Mean number of OCS claims was reduced by 29% from 12 months before to 12 months after treatment (6.6 vs. 4.7; P < .001), and mean number of OCS bursts was reduced by 35% during follow-up (2 vs. 1.3; P < .001), according to the results.In addition, Lugogo said 61.3% of patients with a history of high cost reduced their OCS dose by at least 50% during the follow-up period.
Mean asthma exacerbation costs were also reduced during follow-up for inpatient care ($3,817 vs. $2,356) and outpatient care ($4,545 vs. $2,411) as well as for outpatient prescriptions ($1,035 vs. $603), according to the results. Total costs were in the 12 months before mepolizumab treatment were $9,397 compared with $5,370 after mepolizumab treatment.
“These results suggest that patients with severe asthma will use the majority of resources and account for most of the health care system spending as defined by high-cost demonstrated clinically significant benefit from mepolizumab in a real-world setting,” Lugogo said.