Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma

ObjectivesTo compare clinical outcomes and costs between two administration strategies of omalizumab treatment.MethodWe evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B.ResultsWe studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50±15 years, FEV1% 67±22%, body mass index (BMI) 28±6 kg/m2, 639±747 UI IgE/mL, followed for 24±11 months (12–45), Asthma Control Test (ACT) score 12±4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<.001), ACQ (P<.001), improvement in FEV1% (P<.001), reduction in total admissions (P<.001), days of hospitalization (P<.001), emergency room visits (P<.001), cycles and doses of oral steroids (P<.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A.ConclusionThe administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

ResumenObjetivosEvaluar los resultados clínicos y los costes de 2 estrategias de administración de omalizumab.MétodoSe compararon, de forma retrospectiva, 2 cohortes de pacientes con asma grave no controlada: una, procedente del hospital A, en la que el tratamiento se administró en un centro de salud, y otra, procedente del Hospital B, con administración hospitalaria convencional.ResultadosSe estudió a 130 pacientes, 86 en A y 44 en B, 30 hombres (24%) y 100 mujeres (76%), edad 50 ± 15 años, FEV1% 67 ± 22%, índice de masa corporal (IMC) 28 ± 6 kg/m2, IgE 639 ± 747 UI/mL, seguimiento de 24 ± 11 meses (12-45), Asthma Control Test (ACT) 12 ± 4 y Asthma Control Questionnaire (ACQ) 3 ± 2, sin diferencias significativas basales entre ambas cohortes en ingresos hospitalarios ni visitas a urgencias en el año previo, ni en número de pacientes con esteroides orales. Al comparar la situación basal y tras los 12 meses de tratamiento, se observaron diferencias significativas en ACT (p < 0,001), ACQ (p < 0,001) y mejoría en el FEV1% (p < 0,001), reducción en número de ingresos (p < 0,001), días de hospitalización (p < 0,001), visitas a urgencias (p < 0,001), ciclos y dosis de esteroides p < 0,001) respecto al año previo, tanto individualmente como en conjunto. Los costes de hospitalización, visitas a urgencias, visitas no programadas a Primaria y al neumólogo se redujeron significativamente en ambos hospitales, pero los costes de administración y desplazamiento fueron un 35% inferiores con la pauta ambulatoria en A.ConclusiónLa administración ambulatoria de omalizumab en los centros de salud consigue los mismos resultados clínicos que una pauta de administración hospitalaria, con menores costes.