Poster by Paul Miller: “The Cost-effectiveness of Temperature-controlled Laminar Airflow in uncontrolled severe asthma”
The Cost-effectiveness of Temperature-controlled Laminar Airflow in uncontrolled severe asthma
Paul Miller1, Leif Bjermer2, Stefan Petersson3, Göran Eriksson2, Anoop Chauhan4,
1Miller Economics Ltd, BIOHUB Alderley Park, Alderley Edge, UK; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund; 3StatMind Statistical and Mathematical Modelling, Innovation and Design AB, Lund, Sweden; 4Portsmouth Hospitals NHS Trust and University of Portsmouth, Portsmouth, UK
Current guidelines for patients with uncontrolled severe asthma already on maximal inhaled treatments recommend addition of biologics in preference to oral steroids. Temperature-controlled Laminar Airflow (TLA), now recommended by Swedish authorities, is an effective, safe and cost-attractive alternative (1). A recent study (2) in patients with severe asthma failed to show effect on exacerbations and cost effectiveness, mainly driven by a smaller response among the less symptomatic patients. The objective of this post-hoc study was to investigate the effect of TLA over placebo (PBO) on severe exacerbations and cost-effectiveness in the more
The one-year placebo-controlled, double-blind trial (2), including 216 patients with ACQ data, was re-analysed for effects on exacerbation rates and cost-effectiveness by baseline markers of asthma control. To define the more symptomatic patients, ACQ>3 and EQ5D-VAS≤65 (approximate median values) were used as cut-points. Negative binomial regression was used for analysis of severe exacerbations and Mixed Model for Repeat Measures (MMRM) was used for EQ5D-5L utility data.
The ACQ>3 (N=93) and EQ5D-VAS≤65 (N=137) sub-groups showed a trend for greater treatment effects with a 33% (p=0.083) and 31% (0.073) reduction, respectively, in severe exacerbations in favour of TLA. Total AQLQ improved 0.31 (p=0.085) and 0.33 (p=0.034) score units with AQLQ and EQ5D-VAS, respectively, as covariates. These results are consistent with another 12-month study (3). The difference in overall quality-of-life (EQ5D-5L) scores between TLA and placebo in more symptomatic patients was significant (0.10, p=0.046) (Figure 1) resulting in an incremental cost-effectiveness ratio (ICER) of around £20,000, which is within the NICE-acceptable range (<£30,000 per Quality-Adjusted Life-Year (QALY) gained) (Figure 2).
The magnitude of treatment effect for TLA is much more pronounced in more symptomatic severe asthma patients and TLA is shown to be cost-effective in this sub-group population.
This result aligns with a recent meta-analysis that also shows a beneficial effect on severe exacerbations and quality of life for TLA over placebo in more symptomatic patients with severe allergic asthma (4).
1). Brazier P, Schauer U, Hamelmann E, Holmes S, Pritchard C, Warner JO. Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic
asthma. BMJ Open Respir Res. 2016;3(1):e000117.
2). Kapoor M, Storrar W, Balls L, Brown T, Mansur A, Hedley E, et al. Nocturnal temperature-controlled laminar airflow device for adults with severe allergic asthma: the LASER RCT. Health Technol Assess 2019;23(29):1-140.
3). Chauhan AJ, Brown TP, Storrar W, Bjermer L, Eriksson G,Radner F, Peterson S, Warner JO. Effect of nocturnal Temperature-controlled Laminar Airflow on the reduction of severe exacerbations in patients
with severe allergic asthma: a meta-analysis. European Clinical Respiratory Journal. 202;1 8:1.
4). Chauhan A., et al. Effect of nocturnal Temperature-controlled Laminar Airflow on the reduction of severe exacerbations in patients with severe allergic asthma: a meta-analysis. Eur Clin Respir J. 2021; 8(1): 1894658.