Cost-effectiveness of omalizumab for the treatment of chronic spontaneous urticaria

BackgroundChronic spontaneous urticaria (CSU) is a skin disease with itchy hives and/or angio-oedema that last for at least 6weeks without an obvious external trigger. ObjectivesTo determine the cost-effectiveness of omalizumab relative to standard of care (SoC; up to four times the daily dose of H-1-antihistamines) in the Netherlands from a societal perspective. MethodsThe Markov model used consisted of five health states based on Urticaria Activity Score over 7days. Model settings and characteristics of the Dutch patient population were based on an online survey among clinical experts and were validated during an expert committee meeting. Transition probabilities were derived from the GLACIAL trial. Healthcare consumption, quality of life (using EuroQol-5D) and productivity losses were derived from a burden-of-illness study (ASSURE-CSU) among 93 Dutch patients. Healthcare consumption and productivity losses were evaluated using the Dutch costing manual. The comparator treatment was SoC, consisting of (updosed) antihistamines. A 10-year time horizon was used. ResultsThe incremental cost-effectiveness ratio (ICER) of omalizumab vs. SoC was Euro17502 per quality-adjusted life-year (QALY) gained. Productivity costs played an important role in the value of the ICER; discarding productivity costs resulted in an ICER of Euro85310 per QALY. ConclusionsOmalizumab is cost-effective compared with SoC. The outcomes of this study were used to establish omalizumab as third-line therapy in the Dutch treatment guidelines for CSU.