Determinants of Cost-Effectiveness results of Biological Therapies for Severe Asthma: a systematic methodological assessment.

Objective: to assess the associations between cost-effectiveness analysis' (CEA) methodological characteristics and Incremental Cost-Effectiveness Ratio (ICER) outcomes and conclusions, in biological treatments for asthma.

Study Design And Setting: We included CEAs comparing biological treatments to standard care, in adults with severe asthma. We performed a search in MEDLINE, EMBASE, and Web of Science (Sep 2022). We extracted and summarised CEA's characteristics and critically appraised the studies using the extended Consensus Health Economic Criteria (e-CHEC). In those reporting benefits as quality-adjusted life years (QALY), we conducted bivariate and regression analyses.

Results: We identified 33 CEAs that showed overall good quality (above 66.6% of compliance) with variable results across e-CHEC sections. We included 28 cost-utility analysis (CUA) on biological treatments in asthma in our analysis. Only industry sponsorship showed significant differences in the bivariate analysis (p=0.021 for the difference in ICER medians, and p=0.027 for the different percentage in reported cost-effectiveness). In the regression adopting a non-lifetime horizon and non-use of a model (β = 4.25 and β = 0.16, p<0.05), significantly associated in the multivariate ananlysis. Only non industry sponsorship showed a significant association with the drug being reported as not cost-effective, both in the bivariate and multivariate analysis (OR = 13.2, and OR = 20.15 p<0.05).

Conclusion: Our study identified significant limitations, including poor reporting practices and the impact of industry sponsorship on outcomes, with notable effects on cost-effectiveness conclusions.These findings highlight the need for policymakers and healthcare decision-makers to meticulously consider methodological rigour and potential biases in economic evaluations.