Real-life study of the cost-effectiveness of benralizumab vs previous care in Bulgaria

The aim is to evaluate the cost-effectiveness of benralizumab therapy in real-life settings in Bulgaria in comparison with previous care. The point of view is that of the national health insurance fund, and the time horizon is for one year. This study is based on findings from the BREEZE study for Bulgaria. 80 eligible patients with severe eosinophilic asthma were followed for 56 weeks after the initiation of the therapy with benralizumab. Pharmacotherapy costs pre- and post-initiation of benralizumab therapy were calculated. Outcome measurements were changes in the asthma control test (ACT), forced expiratory volume (FEV1), and the percentage of patients with exacerbations. The mean pharmacotherapy cost was 3653.48 BGN before benralizumab and 19,581.69 BGN after benralizumab inclusion. Yearly costs for benralizumab per patient were estimated to be 5.35 times higher than previous therapy, amounting to 19,581.70 BGN vs. 3,653.48 BGN. Improvement in FEV1 leads to an incremental cost-effectiveness ratio (ICER) of 24,133.70 BGN (12,376.26 EUR). The incremental cost per avoided exacerbation was 22,046.90 BGN (11,304.10 EUR), and improvement in ACT resulted in an ICER of 1,146.33 BGN per point increase. Deterministic sensitivity analysis showed the highest ICER value of 2,392.52 BGN (1,266.93 EUR) per point improvement when benralizumab effectiveness decreased by 30% (ACT score = 16.89). Probabilistic sensitivity analysis showed 98.7% and 99.5% probability of cost-effectiveness below the thresholds of 1×GDP and 3×GDP per capita, respectively. Benralizumab is cost-effective in comparison with previous care for patients with severe asthma based on real-life observation during the BREEZE study in Bulgaria from the point of view of a third-party payer.