Tuesday, October 20, 2015: 2:15 PM
Grand Ballroom C (Hyatt Regency St. Louis at the Arch)

Joe Zein, MD1, Michelle Menegay, MPH1, Mendel E. Singer, PhD1, Serpil Erzurum, MD2, Thomas Gildea, MD2, Joseph Cicenia, MD2, Sumita Khatri, MD2, Mario Castro, MD3 and Belinda Udeh, PhD, MPH4, (1)Case Western Reserve University, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Washington University School of Medicine, Saint Louis, MO, (4)Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
Purpose: Bronchial thermoplasty (BT) uses radiofrequency to reduce smooth-muscle mass within airways. BT is effective in reducing exacerbations and improving quality of life (QOL). It was approved by the Food and Drug Administration (FDA) in 2010 to be performed as an outpatient intervention for treatment of severe persistent asthma in adults, not controlled with medication. This study assessed BT’s clinical and economic outcomes at 5 and 10 years for individuals with severe uncontrolled asthma.
Method: A cost-effectiveness analysis was conducted from a healthcare perspective. A Markov model was constructed, evaluating the cost-effectiveness of BT compared to usual care (UC). Model inputs included all direct healthcare costs, cost-savings from exacerbation reduction, and QOL benefits from exacerbation and mortality reduction. Utilities and costs were obtained from recent clinical trials and secondary data sources. Outcomes were measured in quality adjusted life years (QALY), incremental cost-effectiveness ratios (ICERs) and clinical events including hospitalizations. The analysis was conducted at 5-years, the time-frame of the clinical trials, and 10-years, a conservative estimate of BT’s minimum effectiveness. Deterministic and probabilistic sensitivity analysis (PSA) was performed to assess the robustness of the model and inputs to population and parameter changes.
Result: BT had an ICER of $45,170/QALY at 5-years, and $29,821/QALY at 10 years compared to UC. At both time frames, BT’s ICER was below the conservative willingness to pay threshold (WTP) of $50,000/QALY. Other outcomes indicated at 10 years, the BT group would have $4,633 less in ER and hospitalization costs, and $2,592-$4,244 less in medication costs.
Sensitivity analysis indicated results were sensitive to the cost of BT and probability of exacerbations in the BT and UC group. At 10-years, two thresholds were identified. At a WTP of $50,000, if the cost of the BT series exceeded $10,384 or if the probability of exacerbations fell below 0.63/year with UC, BT would no longer be cost-effective. PSA produced results similar to the baseline analysis. The cost-effectiveness acceptability curve summarized BT would be cost-effective at 10-years with a 93.3% probability for a WTP of $50,000.
Conclusion: BT is likely to be a cost effective treatment for asthmatics at high risk of exacerbations. Continuing to follow asthmatics treated with BT beyond five-years will help inform longer efficacy and support its cost-effectiveness.