Dupilumab Among Patients with Uncontrolled Severe Asthma in China: A Cost-Utility Analysis

Zheng Liu,1 Maosheng Xu,2 Huifang Zhu,1 Jinzhen Huang,1 Xuhui Ye,1 Xintian Shen,1 Xiaomei Fan1 1Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, 518102, People’s Republic of China; 2Department of Respiratory, Guangzhou Panyu District Maternal and Child Health Hospital, Guangzhou, 511400, People’s Republic of ChinaCorrespondence: Xiaomei Fan, Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, 518102, People’s Republic of China, Email [email protected]: Dupilumab’s recent approval in China as an add-on therapy for asthma provides a novel therapeutic alternative for severe asthma management, but its economic benefits remain unsubstantiated in China. This study aimed to adopt a cost-utility analysis to evaluate the economics of dupilumab in the treatment of uncontrolled severe asthma and provide an evidence-based reference for clinical decision-making and therapeutic regimen selection.Methods: From the healthcare perspective, a Markov model was developed to simulate costs and quality-adjusted life years (QALYs) over a five-year time horizon for uncontrolled severe asthma patients aged ≥ 12 years receiving either dupilumab add-on therapy or standard-of-care (SoC) therapy alone. The incremental cost-utility ratio (ICUR) served as the primary outcome and was compared with the willingness-to-pay (WTP) threshold based on per capita gross domestic product (GDP) of China ($13,444.68/QALY) to determine the economics of therapeutic alternatives. The robustness of the results was verified using sensitivity analysis, and the impact of the dupilumab price on outcomes was evaluated using scenario analysis.Results: Compared with SoC therapy, dupilumab add-on therapy incurred higher costs but provided greater utility gains, with an ICUR of $83,941.87 per QALY gained, which exceeded the WTP threshold. One-way sensitivity analysis identified the utility of controlled asthma as the predominant influential factor, followed by the price of dupilumab. Probabilistic sensitivity analysis showed that 98.8% of simulations were consistent with the base-case results, and SoC therapy had a higher probability of cost-utility acceptability than dupilumab add-on therapy. Scenario analysis revealed that reducing dupilumab’s price to $70.38 would render its ICUR below the WTP threshold.Conclusion: Based on the current Chinese healthcare system, it was not cost-utility to apply dupilumab as an add-on therapy for patients aged ≥ 12 years with uncontrolled severe asthma. A substantial price reduction of dupilumab could improve affordability in this patient population.Keywords: dupilumab, biologics, severe asthma, pharmacoeconomics, cost-utility analysis