Clinical efficacy and cost-effectiveness of mepolizumab for COPD with type 2 inflammation

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Approximately 20–40% of patients exhibit eosinophilic inflammation; a phenotype linked to higher exacerbation risk. Mepolizumab, an anti-IL-5 biologic, has shown clinical benefit in reducing exacerbations among eosinophilic COPD patients. Its cost-effectiveness, however, remains uncertain in low- and middle-income countries. A Markov model was developed to estimate the long-term cost-effectiveness of mepolizumab plus triple therapy versus triple therapy alone in eosinophilic COPD from the Colombian healthcare system perspective. Clinical effectiveness was informed by a meta-analysis of five randomized controlled trials. Costs and utilities were obtained from Colombian sources. A lifetime horizon, 5% discount rate, and willingness-to-pay (WTP) threshold of $5,180 USD/QALY were applied. Deterministic and probabilistic sensitivity analyses were conducted. Mepolizumab reduced exacerbation risk by 14% (RR: 0.86; 95% CI: 0.77–0.95). The incremental cost-effectiveness ratio was $45,192 per QALY gained, exceeding the WTP threshold. Net monetary benefit favored standard care, and the probability of cost-effectiveness was 0% under base-case assumptions. Although clinically effective, mepolizumab is not cost-effective in Colombia at current pricing. Price reductions and outcome-based reimbursement strategies are needed to improve economic viability.