Study Finds Omalizumab More Cost Efficient Than Other CSU Management Strategies

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Treatment with omalizumab, 300 mg, for H1 antihistamine–refractory chronic urticaria (CU) may be considered cost-effective from a third-party payer’s viewpoint, new findings suggest, whereas routine laboratory testing among patients may be cost-inefficient.¹

These results were from a new study authored in part by Surapon Nochaiwong, PharmD, from the department of pharmaceutical care at Chiang Mai University in Thailand. Nochaiwong’s team sought to explore the costs and net benefits of treatment for CU, noting that data in this space had not yet been comprehensively explored.

“Previous literature reviews are mainly focused on reporting the impact of those strategies on subcomponents of health care costs; however, evidence regarding the total costs and cost-effectiveness of CU management have yet to be comprehensively synthesized,” Nochaiwong et al. wrote.^1,2

Trial Design Background

The research team used several electronic databases for their treatment search strategies, specifically looking at Embase, MEDLINE, PubMed, Scopus, Cochrane, and CINAHL. Without language restrictions, the team used both Medical Subject Headings and free-text terms associated with CU and economic evaluation for their searches.

The investigators cross-checked the references of relevant research for the purposes of ensuring no pertinent articles were missed. The search was updated in March 2024.

Two members of the research team screened the abstracts and titles independently, determining which studies met their pre-determined inclusion criteria. Those which were shown to be relevant but were non-English language were given a translation for the review.

The research team sought to maximize diversity of healthcare settings, doing so by considering international collaboration studies. Information from various interventions and modeling scenarios was also collected by the team, utilizing a standardized extraction form which had been developed.

They determined that research had ro conduct a full economic evaluation in order to qualify for inclusion. Such research could include cost-utility analysis (CUA), cost-effectiveness analysis (CEA), cost-benefit analyses, or analyses of cost-minimization.

The investigators also decided research could be included provided it assessed costs associated with CU treatment, diagnosis, or management and reporting incremental cost-effectiveness ratios (ICERs) or yearly costs of healthcare. They would not include studies based upon non-empirical data, research which involved unclear estimates of costs, or reviews.

Study Conclusions

The investigators concluded their study with 17 studies having been included, with 11 cost analyses and 6 full economic evaluations specifically. Significant variability in healthcare resources was reported in their assessment of this research.

Use of the biologic omalizumab was shown by the research team to have higher yearly healthcare costs for management of CU management versus management without it. Specifically, the team highlighted that the drug involved a median cost of $6,933 versus $5,621 without it.

Omalizumab, at a dose of 300 mg for H1 antihistamine-refractory chronic spontaneous urticaria (CSU), had been assessed within 3 studies. The team concluded, however, that it had a median ICER of $89,005 per QALY, with moderate certainty and net health benefits which were significant.

In contrast, the investigators found that routine laboratory testing for those with CSU who had otherwise normal physical exams and histories was shown to have ICERs which were between $1,427,928 - $1,950,524 per QALY. This indicated comparable or inferior net health benefits, they noted.

“With limited cost-effectiveness evidence for interventions focused on CU management, this systematic review suggests that biologic omalizumab, 300 mg, for H1 antihistamine–refractory CSU appears to be cost-effective based on the WTP threshold of $150 000 per QALY,” they wrote. “At this threshold, routine laboratory testing among patients with CSU with otherwise normal histories and physical examination findings was not cost-effective compared with the no-testing approach.”

References

1. ^{Nochaiwong S, Chuamanochan M, Ruengorn C, Awiphan R, Bernstein JA, Thavorn K. Cost and Cost-Effectiveness of the Management Strategies of Chronic Urticaria: A Systematic Review. JAMA Dermatol. Published online August 28, 2024. doi:10.1001/jamadermatol.2024.2863.}
2. ^{Igarashi A, Yuasa A, Yonemoto N, et al. A systematic literature review of economic evaluations and cost studies of the treatment of psoriasis, atopic dermatitis, and chronic urticaria. Dermatol Ther (Heidelb). 2022;12(8):1729-1751. doi:10.1007/s13555-022-00774-2.}