Cost-Effectiveness of Omalizumab in Chronic Idiopathic Urticaria Refractory to H1-Antihistamines in Turkey

Omalizumab is a humanised anti-IgE recombinant monoclonal antibody approved in Turkey for treatment of chronic idiopathic (or spontaneous) urticaria (CIU) in patients resistant to standard treatment. We aimed to assess the cost-effectiveness of omalizumab compared with the standard care in the treatment of CIU patients in Turkey. A Markov model of 10 years horizon was developed to estimate costs and outcomes associated with omalizumab 300mg/every 4 weeks and standard of care for 24 weeks (SoC=licensed dose H1 antihistamines) using data from two phase III studies (ASTERIA I&II includes patients with CIU refractory to licensed dose of H1-antihistamines). The study was undertaken from a Turkish health care payer perspective. At the end of this period, omalizumab was stopped and background medication continued. Patients who have responded were retreated by the same strategy upon relapse (UAS7 ≥16 or ≥28). We used Urticaria Activity Score 7 (UAS7) to measure the outcome of the treatment and we used symptom free days (UAS7 ≤6) as the outcome measure in this cost effectiveness analysis. Resource utilization data were obtained via a Delphi panel. Unit costs were taken from the Social Security Institution’s official list. Costs and outcomes were evaluated over a lifetime and discounted at 3%. Results were presented as incremental cost/symptom free days. The incremental symptom free days with omalizumab versus SoC was 27,965 days and the incremental cost was 1,610,349 Turkish Liras for 100 patients over 10 years. The incremental cost per symptom free day was 57.59 Turkish Liras. One-way sensitivity analyses confirmed the robustness of the model results. CIU affects the quality of life of patients and is associated with direct and indirect costs to payers and society. We believe that omalizumab 300mg Q4wks is a cost-effective treatment option for patients with refractory CIU in Turkish setting.