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Reslizumab for Treating Asthma with Elevated Blood Eosinophils Inadequately Controlled by Inhaled Corticosteroids: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

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Abstract

As part of the National Institute for Health and Care Excellence (NICE) Single Technology Appraisal (STA) process, the manufacturer of reslizumab (Teva) submitted evidence for its clinical and cost effectiveness for the treatment of eosinophilic asthma inadequately controlled by inhaled corticosteroids. NICE commissioned Southampton Health Technology Assessments Centre (SHTAC) as an independent Evidence Review Group (ERG) to provide a critique of the manufacturer’s submitted evidence. Reslizumab is compared with best standard of care and omalizumab, for a small ‘overlap’ population of patients who have both eosinophilic and IgE-mediated severe asthma. This paper provides a summary of the ERG’s review of the manufacturer’s submission, and summarises the NICE Appraisal Committee’s subsequent guidance (issued in August 2017). The ERG considered that there were limitations in the approach proposed by the manufacturer for the exacerbation rate and the utility for severe exacerbation. The company amended their initial analysis, following comments from the ERG and the NICE committee, whereby the incremental cost effectiveness ratio was £29,870 per QALY gained for reslizumab compared with best standard care. The NICE Appraisal Committee (AC) concluded that reslizumab was recommended as an option for the treatment of severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids plus another drug, only if (1) the blood eosinophil count has been recorded as 400 cells per microlitre or more and (2) the patient has had three or more asthma exacerbations in the past 12 months, and (3) the company provides reslizumab with the discount agreed in the patient access scheme.

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Acknowledgements

This summary of the ERG report was compiled after NICE issued the FAD. All authors have commented on the submitted manuscript and have given their approval for the full version to be published. The view and opinions expressed here are those of the authors and do not necessarily reflect those of NICE or the Department of Health. Any errors are the responsibility of the authors.

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Authors and Affiliations

  1. Faculty of Medicine, Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK

    Keith Cooper, Geoff Frampton, Petra Harris, Micah Rose, Maria Chorozoglou & Karen Pickett

Authors
  1. Keith Cooper
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  2. Geoff Frampton
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  3. Petra Harris
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  4. Micah Rose
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  5. Maria Chorozoglou
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  6. Karen Pickett
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Contributions

KC and MR critically appraised the health economic systematic review, critically appraised the economic evaluation and drafted the report. PH and KP critically appraised the clinical effectiveness systematic review and drafted the report. MC critically appraised the economic evaluation and drafted the report. GF critically appraised the clinical effectiveness systematic review, drafted the report, project managed the review and is the project guarantor. This summary has not been externally reviewed by PharmacoEconomics.

Corresponding author

Correspondence to Keith Cooper.

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Funding

This work was funded by the National Institute for Health Research Health Technology Assessment programme as Project number 15/121/14.

Conflict of interest

All authors (KC, GF, PH, MR, MC and KP) had no conflicts of interest.

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Cooper, K., Frampton, G., Harris, P. et al. Reslizumab for Treating Asthma with Elevated Blood Eosinophils Inadequately Controlled by Inhaled Corticosteroids: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PharmacoEconomics 36, 545–553 (2018). https://doi.org/10.1007/s40273-017-0608-z

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