Cost-effectiveness of bronchial thermoplasty for severe asthmatic patients in Japan

Published on Dec 31, 2020
· DOI :10.35772/GHM.2020.01067
Shuichiro Matsumoto2
Estimated H-index: 2
,
Motoyasu Iikura21
Estimated H-index: 21
+ 14 AuthorsMasao Hashimoto8
Estimated H-index: 8
Sources
Abstract
Bronchial thermoplasty (BT) is an interventional endoscopic treatment for severe bronchial asthma. Some studies have shown the clinical efficacy of this intervention, but its cost-effectiveness is unclear. The aim of this study was to evaluate the cost-effectiveness of BT. We collected data from the medical records of 16 Japanese patients who were treated with BT between February 2015 and April 2017, and compared asthma-related medical expenses between the year preceding and the year following BT. Four patients were Global Initiative for Asthma (GINA) treatment step 4, and 12 were step 5. In 8 patients who had a successful response to BT, the annual asthma-related medical expenses decreased because of a reduction in hospitalization and emergency outpatient visits due to asthma attacks, and termination of the use of biologics. Most patients in the non-responder group had increased asthma-related medical costs postoperatively. The main reason for the increase in medical costs was the add-on treatment of biologics. BT was cost-effective in the responder group. If its effects continue for more than 10 years, BT will be a cost-effective treatment. Medical costs will be reduced if those who respond to BT can be identified prior to commencement of treatment.
References11
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#2Wei Wang (Monash University, Clayton campus)H-Index: 14
Last. Francis Thien (Monash University, Clayton campus)H-Index: 39
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Abstract Background Whilst it is established that not all patients respond to bronchial thermoplasty (BT), the factors that predict response/non-response are largely unknown. Objectives The aim of this study was to identify baseline factors that predict clinical response. Methods The records of 77 consecutive patients entered into the Australian Bronchial Thermoplasty Register were examined for baseline clinical characteristics, and outcomes measured at 6 and 12 months post BT, such as change in...
9 CitationsSource
#1Haruhito SugiyamaH-Index: 19
#2Motoyasu IikuraH-Index: 21
Last. Masayuki HojoH-Index: 3
view all 4 authors...
Bronchial Thermoplasty (BT) is an epoch-making treatment that reduces bronchial smooth muscle by using a bronchoscope to reach the basket catheter to the bronchus and directing high-frequency current directly into the bronchi. In GINA Guidelines 2019, BT is considered to be additional treatment at Step V (the most severe), and the evidence level is B. The Japanese guidelines (JGL) also added BT as a treatment for Step 4, but it is reserved because there are still unclear points regarding long-te...
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#1Rekha Chaudhuri (Gartnavel General Hospital)H-Index: 34
Last. Michel Laviolette (Laval University)H-Index: 64
view all 17 authors...
Background: BT is an endoscopic treatment for uncontrolled asthma. The long-term efficacy and safety of BT beyond 5 years is not known. Objective: To evaluate the efficacy and safety of BT at 10+ years follow-up. Methods: BT10+ is an international, multi-center, ≥10yrs follow-up study on subjects who were previously enrolled in the AIR, RISA and AIR2 trials. Demographics, quality of life, lung function, severe exacerbations (SE, defined as exacerbations requiring systemic corticosteroids) and he...
3 CitationsSource
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#2Saideep BoseH-Index: 9
Last. Mariko Siyue Koh (NUS: National University of Singapore)H-Index: 18
view all 9 authors...
Background and objective Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a g...
12 CitationsSource
#1Zafar Zafari (UBC: University of British Columbia)H-Index: 12
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Background Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.
38 CitationsSource
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AbstractRationale: Based on its clinical effectiveness, bronchial thermoplasty (BT) was approved by the Food and Drug Administration in 2010 for the treatment of severe persistent asthma in patients 18 years and older whose asthma is not well-controlled with inhaled corticosteroids and long-acting beta-agonist medicines. Objective: Assess the 10 year cost-effectiveness of BT for individuals with severe uncontrolled asthma. Methods: Using a Markov decision analytic model, the cost-effectiveness o...
19 CitationsSource
Objectives: We examined the cost–effectiveness of treating poorly controlled, severe, persistent asthma patients with bronchial thermoplasty (BT), a novel technology that uses thermal energy to reduce airway smooth muscle mass, with 5-year outcome data demonstrating a durable reduction in asthma exacerbations. Study design: We conducted a model-based cost–effectiveness analysis assessing 5-year healthcare utilization, patient quality of life and adverse events. Methods: We utilized Markov modeli...
17 CitationsSource
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#2Michel Laviolette (Laval University)H-Index: 64
Last. Mario Castro (WashU: Washington University in St. Louis)H-Index: 85
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Background Bronchial thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy. Methods BT-treated subjects from the Asthma Intervention Research 2 trial (ClinicalTrials.gov NCT01350414) were evaluated annually for 5 years to assess the long-term safety of BT and the durability of its treatment effect. Outcomes assessed...
195 CitationsSource
#1Mario Castro (WashU: Washington University in St. Louis)H-Index: 85
Last. Gerard Cox (McMaster University)H-Index: 50
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Rationale: Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. Objectives: To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic despite treatment with high-dose inhaled corticosteroids and long-acting β2-agonists. Methods: A total of 288 adult subjects (Intent-to-Treat [ITT]) randomized to BT or sham control underwent three bronc...
727 CitationsSource
#1Wendy C. Moore (NIH: National Institutes of Health)H-Index: 46
#2Eugene R. Bleecker (NIH: National Institutes of Health)H-Index: 119
Last. Sally E. Wenzel (University of Pittsburgh)H-Index: 115
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Background Severe asthma causes the majority of asthma morbidity. Understanding mechanisms that contribute to the development of severe disease is important. Objective The goal of the Severe Asthma Research Program is to identify and characterize subjects with severe asthma to understand pathophysiologic mechanisms in severe asthma. Methods We performed a comprehensive phenotypic characterization (questionnaires, atopy and pulmonary function testing, phlebotomy, exhaled nitric oxide) in subjects...
836 CitationsSource
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