Indirect comparison of bronchial thermoplasty versus omalizumab for uncontrolled severe asthma.

OBJECTIVE: Bronchial thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM. METHODS: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology. RESULTS: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA). Comparing the BT post-treatment period to ongoing treatment with OM, showed no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM = 0.91 [95% CI: 0.64, 1.30]; p = 0.62) or hospitalizations (RR = 0.57 [95% CI: 0.17, 1.86]; p = 0.53); emergency department visits were significantly reduced by 75% with BT (RR = 0.25 [95% CI: 0.07, 0.91]; p = 0.04); the proportions of patients with clinically meaningful response on the asthma quality-of-life questionnaire were comparable (RR = 1.06 [95% CI: 0.86, 1.34]; p = 0.59). The RR for exacerbations statistically favours OM over the total study period in AIR2 (RR = 1.50 [95% CI: 1.11, 2.02]; p = 0.009) likely reflecting a transient increase in events during the BT peri-treatment period. CONCLUSIONS: The ITC should be interpreted cautiously considering the differences between patient populations in the included trials. However, based on the analysis, BT compares well with a potentially more costly pharmacotherapy for asthma. Clinicians evaluating the relative merits of using these treatments should consider the totality of evidence and patient preferences to make an informed decision.

Estimating utility scores in young children with acute rotavirus gastroenteritis in the UK.

OBJECTIVE: To estimate utility scores for different severities of acute rotavirus gastroenteritis in children aged<5 years in the UK. METHODS: UK general practitioners (n=25) and paediatricians (n=25) rated four different health state descriptions of acute rotavirus gastroenteritis using the EuroQol (EQ-5D) questionnaire for children aged<18 months and 18 months to 5 years. EQ-5D scores were modified to account for limited self-care and mobility, and converted into utility values using the standard algorithm using UK data. RESULTS: General practitioners rated the mean utility for primary care cases at 0.781 (standard deviation (SD) 0.263) and 0.688 (SD 0.345) for the younger and older age groups, respectively. For hospitalised cases the corresponding scores were 0.425 (SD 0.243) and 0.200 (sd 0.386). Paediatricians rated the mean utility for hospitalised severe cases at 0.595 (SD 0.171) and 0.634 (SD 0.217) in the younger and older groups, respectively, and for hospitalised very severe cases at 0.256 (SD 0.251) and 0.077 (SD 0.340), respectively. In all cases, the utility differences between the health states were statistically significant (p<0.0001). CONCLUSIONS: Acute rotavirus gastroenteritis substantially impairs quality of life in children aged<5 years as rated by health professionals. This study provides useful quantitative utility estimates for economic evaluations.