What is the cost-effectiveness of bronchial thermoplasty (BT)?

Updated: Mar 30, 2021
  • Author: Said A Chaaban, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Though patients with severe asthma constitute 5-10% of the asthma population, severe asthma consumes a disproportionate percentage (~50%) of the global asthma budget, secondary to unscheduled physician visits, emergency department (ED) visits, and hospitalizations, along with the costs of pharmacotherapy.

The high use of resources for this group of patients, along with the increased morbidity and mortality, led to the formation of the European, American, and global severe asthma networks with the aim of achieving a better understanding of the pathogenesis and thereby becoming better able to direct optimal management. One of the major challenges in the treatment of asthma is how to select those patients that would respond best to a specific therapy. [11]

A 5-year budget impact analysis was performed in Italy. [12]  This study, the first of its kind, evaluated adding adjuvant BT to the standard care with or without adjuvant omalizumab. The authors concluded that despite the increase in direct costs due to the add-on therapies, the overall long-term cost was less, with a decrease in the number of ED visits and hospitalizations. [13, 12]

In a study of commercially insured patients, based on a cost-effectiveness analysis evaluating 5-year healthcare utilization along with patient quality of life and adverse events, BT was shown to be a cost-effective treatment for patients with severe persistent asthma. [14]

Because BT is associated with a very high direct cost, insurance coverage has been a prominent issue. [15]  In the United States, BT is covered by multiple commercial payers. It is also covered by multiple, though not all, health plans, and some health plans that do not routinely cover it may still consider it on a case-by-case basis and provide coverage on the basis of case-specific medical necessity.

Payers with noncoverage policies have typically used a number of reasons for maintaining such policies. Many plans have described BT as an “experimental and investigational” procedure, suggesting that further study is necessary before coverage is appropriate. It is always recommended that patients confirm commercial insurance coverage before starting this therapeutic modality.

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