CHEST Guidelines-Use-of-Biological-Agents-in-Asthma

Use-of-Biological-Agents-in-Asthma_chest

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The document discusses the use of biological agents, specifically monoclonal antibodies like omalizumab, in treating severe asthma that remains uncontrolled despite traditional treatments. A significant portion of asthma patients experiences inadequate control, emphasizing the need for effective biological therapies. Omalizumab, an anti-IgE therapy, is described as a treatment option for these patients.<br /><br />Key issues addressed include the need for careful patient stratification as not all patients respond equally to biological treatments. Despite being multiple potential predictors of response, such as biomarkers, there remains a disconnect between current prescribing criteria and anticipated therapeutic outcomes. The economic implications of these therapies are substantial, with high treatment costs that may not justify the marginal improvements in some cases. The per-patient annual cost of omalizumab in the U.S. varies between $15,000 and $44,000, and its use may reduce hospital admissions but also increase the overall cost of asthma care.<br /><br />The text suggests these agents should be reserved for patients most likely to benefit, recognizing specific phenotypes predictive of positive responses. Economic evaluations, like quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER), indicate a significant financial burden despite some improvements in health outcomes. The disparity in prescribing costs and healthcare savings between regions like Europe and the U.S. complicates these assessments further.<br /><br />Ultimately, the paper calls for refined guidelines and thorough understanding of asthma phenotypes to enhance the cost-effectiveness of monoclonal antibody therapies. The potential benefits of improving quality of life and productivity, alongside other indirect cost savings, must be balanced against the substantial direct medical costs of biologics like omalizumab in an economically constrained healthcare system.

Keywords

biological agents

monoclonal antibodies

omalizumab

severe asthma

anti-IgE therapy

patient stratification

economic implications

cost-effectiveness

asthma phenotypes

healthcare costs