Determinants of cost-effectiveness results of biological therapies for severe asthma: a systematic methodological assessment

OBJECTIVES: To assess the associations between cost-effectiveness analysis' (CEA) methodological characteristics and incremental cost-effectiveness ratio 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 (September 2022). We extracted and summarized CEA's characteristics and critically appraised the studies using the extended Consensus Health Economic Criteria. In those reporting benefits as quality-adjusted life years, 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 extended Consensus Health Economic Criteria sections. We included 28 cost-utility analyses on biological treatments in asthma in our analysis. Only industry sponsorship showed significant differences in the bivariate analysis (P = .021 for the difference in incremental cost-effectiveness ratio medians, and P = .027 for the different percentage in reported cost-effectiveness). In the regression adopting a nonlifetime horizon and nonuse of a model (β = 4.25 and β = 0.16, P < .05), significantly associated in the multivariate analysis. Only nonindustry sponsorship showed a significant association with the drug being reported as not cost-effective, both in the bivariate and multivariate analysis (odds ratio = 13.2 and odds ratio = 20.15 P < .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 health-care decision-makers to meticulously consider methodological rigor and potential biases in economic evaluations.