Cost effectiveness of treating eosinophilic exacerbations of asthma and COPD with benralizumab: health economic analysis of the ABRA trial

<bold>Background:</bold> Benralizumab is superior to prednisolone when used to treat eosinophilic exacerbations of asthma and COPD. The cost effectiveness of this treatment is unknown. <bold>Aim:</bold> To evaluate the cost-effectiveness of benralizumab compared to prednisolone in patients with an acute exacerbation using total patient level and health care costs from the ABRA trial. <bold>Methods:</bold> Participants were randomised to receive benralizumab (with or without prednisolone) or prednisolone alone. The primary outcome for this analysis is the difference in total 90-day cumulative health service cost between study arms. Additional analyses were performed based on patient disease (asthma or COPD). This analysis did not include the costs of prednisolone related harms. <bold>Findings:</bold> There were 169 treatment failure episodes captured within 90-days. Prednisolone treatment costs £7, but the average cost per treatment failure following an exacerbation was £1733. Benralizumab costs £1500 per dose; the average cost per treatment failure for participants receiving benralizumab alone and benralizumab with prednisolone was £1666 and £2485 respectively. Benralizumab monotherapy for eosinophilic exacerbations saved the health service £237 for every treatment failure prevented. Meanwhile, prednisolone costed the health service £1373 for every treatment failure prevented. Compared to prednisolone standard care, benralizumab monotherapy saved the health service £2373 per asthma treatment failure prevented and saved £1787 per COPD treatment failure prevented. <bold>Conclusion:</bold> Benralizumab is cost effective and reduces the total 90 day treatment costs to treat an exacerbation of asthma and COPD.