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Biologics vs. Surgery for CRSwNP: Is the Bang Worth the Buck?

From top left corner: Christine Franzese, MD; Cecilia Damask, DO; Stella E. Lee, MD; Sarah K. Wise, MD, MSCR

The treatment paradigm for chronic rhinosinusitis with nasal polyposis (CRSwNP) has changed with the advent of biologics, said panelists in Sunday’s session, “FESS, Biologics, and Biomarkers, Oh My!: A Case-Based Approach to Decision-Making for Nasal Polyposis.”

“A biologic,” said Sarah K. Wise, MD, MSCR, a professor at Emory University, “is a drug product that basically comes from some type of biologic source.” There is currently only one FDA-approved biologic option for the treatment of CRSwNP, but a few others are advanced in trial stages and may be widely available in the near future.

With more treatment choices opening up in front of them, Dr. Wise, along with Christine Franzese, MD, a professor at the University of Missouri-Columbia; Stella E. Lee, MD, an associate professor at the University of Pittsburgh; and Cecilia Damask, DO, of Lake Mary Ear Nose Throat in Lake Mary, Florida, discussed real-world patient scenarios to highlight the realities of treatment paths for CRSwNP—particularly in terms of cost.

Five biologics are—or may shortly become—treatment options for patients:

  • Mepolizumab (an anti-IL5 drug)
  • Reslizumab (an antil-IL5 drug)
  • Benralizumab (an anti-IL5R drug)
  • Omalizumab (an anti-IgE drug)
  • Dupilumab (an anti-IL4R drug)

Dr. Franzese, the moderator of the session, has had success in her own practice with Dupilumab, the only drug in the above list that is currently FDA-approved. But as it currently stands, cost may bar some patients from choosing drug therapies over surgery.

“The cost of sinus surgery is really going to depend a lot on where the patient who has the surgery is located in the country,” said Dr. Damask, citing differences like whether the treatment occurs at a surgery center or inside a hospital and what insurance coverage the patient has. “But the estimate is $10,565 for the surgery.”

That price tag, said Dr. Damask, has gone up more than 48% in recent years, even adjusting for inflation. But biologics are no more affordable.

“Overwhelmingly, the cost of these [biologic] treatments seemed way out of proportion to the incremental clinical benefits,” said Dr. Damask. A study from the Incremental Cost Effectiveness Ratio, which determines the accepted amount of cost-effectiveness for therapy to be between $50,000-$100,000 per quality-adjusted life year, found that each of the five biologics for CRSwNP are in the $300,000-plus range.

And so, while asthma studies have shown that all five biologics are considered safe and effective, reduce the number of asthma exacerbations a patient might experience, and improve day-to-day quality of life, the hefty price tag may leave them out of reach of many patients for the time being.

“Sinus surgery, even if the patient had had multiple sinus surgeries, would be more cost effective than Dupilumab, unless the cost of Dupilumab went down to less than $855 per year,” said Dr. Damask.

This event, which was presented September, 13, 11:30 am (ET), will be available in the on-demand library of education content within 48 hours following the presentation.

 

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