Evaluating the influence of health policy on health outcomes: REALITI-A post hoc analysis

<bold>Background:</bold> Mepolizumab treatment reduced the rate of clinically significant exacerbations (CSE) in patients with severe asthma in the REALITI-A study. However, differences between country reimbursement criteria may impact patient selection and outcomes. <bold>Aims and Objectives:</bold> This post hoc analysis of REALITI-A assessed the impact of country reimbursement criteria on clinical outcomes at 1 year. <bold>Methods:</bold> Countries were grouped based on reimbursement criteria restriction (least restrictive [Belgium and USA], moderately restrictive [Canada, Germany, Italy and Spain], most restrictive [UK]). Rate ratios (RRs) of CSE were assessed at 1 year post-mepolizumab treatment compared with 1 year pre-treatment for each country. RRs of CSE in the most and moderately restrictive groups were compared with the least restrictive group. <bold>Results:</bold> Reductions in CSE were observed across all countries post-mepolizumab treatment and across all reimbursement criteria groups. Compared with the least restrictive group, the moderately restrictive group had significantly greater reduction in the RR of CSE (rate difference [log RR; 95% confidence interval]: -0.43 [−0.73; -0.14]; p<0.0042); there was an increase in the RR of CSE in the most restrictive group (0.15 [−0.13; 0.44]; p=0.2786; Figure). <bold>Conclusions:</bold> Country reimbursement criteria may impact the treatment benefit of mepolizumab, influencing clinical outcomes. <bold>Funding:</bold> GSK (204710) <fig><object-id>erj;64/suppl_68/PA1182/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>