Bronchial thermoplasty for the treatment of severe asthma: A single technology assessment
Health technology assessment|
Patients suffering from severe treatment-resistant asthma currently have few available treatment options. For these patients, bronchial thermoplasty (BT) may be an alternative. We have assessed the current evidence base on commission from the National System for Managed Introduction of New Health Technologies within the Specialist Health Service in Norway.
Asthma is a chronic inflammatory illness affecting the airways. Severe asthma is defined as “asthma that is uncontrolled despite maximal optimised therapy and treatment of contributory factors, or that worsens when high dose treatment is decreased”. Patients suffering from severe treatment-resistant asthma currently have few available treatment options, for these patients, bronchial thermoplasty (BT) may be an alternative. BT is a device-based treatment option that uses temperature-controlled radio frequency energy to reduce the amount of airway smooth muscle within the airway wall.
Overall, the current evidence base for bronchial thermoplasty indicates no clear and well documented positive health effect on the most important outcomes. This single-technology assessment shows that:
- The effect of BT on mortality is uncertain
- The risk of hospitalization increased during the BT treatment (first 12 weeks).
- There was no difference in hospital admissions between BT and sham/control after 12 months.
The clinical effectiveness data doesn’t demonstrate a clear difference between BT and control on the rate of exacerbations, hospitalisations, or visits to general practitioner or emergency room. As the central drivers of the suggested health economic model were thus found to be insufficiently documented, the submitted model was not further assessed. Absolute shortfall and severity are not estimated as cost effectiveness is not documented in a cost per QALY analysis. It is estimated that 1258 Norwegian patients with severe asthma may be eligible for bronchial thermoplasty each year. According to the manufacturer, the budget impact when treating 1258 patients with BT would require about 100 million NOK during the first year.