Primary Risk Drivers
Below is a snapshot of domains that materially influence the MARA Rating.
Clinical effectiveness
Tezepelumab demonstrated a clear clinical advantage over placebo in reducing asthma exacerbations and the need for oral corticosteroids, with significant reductions in annualized asthma exacerbation rates (AAER) reported in the PATHWAY and NAVIGATOR trials. The results showed a rate ratio of 0.29 and 0.44 respectively, indicating substantial efficacy. However, the indirect comparisons with other biological treatments showed uncertainty, preventing a higher rating.
Cost effectiveness
Tezepelumab was found to be cost-effective compared to standard care and other biological treatments, with ICERs below £20,000 per QALY gained in the relevant subgroups. The committee noted that the most plausible ICER was unlikely to exceed acceptable thresholds for Healthcare resources, supporting a strong cost-effectiveness rating.
Quality of life
The clinical trials indicated that tezepelumab was associated with improvements in quality of life as measured by EQ-5D-5L compared to placebo. While the improvements were noted, the absence of subgroup analyses for this outcome limits the robustness of the evidence, justifying a moderate rating.
Supporting Domains
Safety and Adverse Effects
Tezepelumab exhibited a very good safety profile, with mostly mild to moderate adverse events reported. Serious adverse events were rare, indicating that the treatment is well-tolerated compared to existing therapies, justifying a strong rating.
Comparator Selection
The evidence included relevant comparators such as standard care and other biological treatments, which are appropriate for assessing tezepelumab’s effectiveness. The committee agreed that these comparators were suitable, although the lack of direct comparisons with other biological treatments introduces some limitations.
Patient Population and Subgroups
The trial populations were considered representative of the Healthcare population with severe asthma, including relevant subgroups based on exacerbation history and corticosteroid use. This broad representation supports a strong rating.
Care Pathway Integration
Tezepelumab can be integrated into existing treatment pathways with minor adjustments, as it serves as an add-on therapy to standard care. The committee noted that its use would not require significant changes to current practices, justifying a good rating.
Resource Use and Cost Implications
The budget impact of tezepelumab is manageable, with the potential for cost savings due to reduced exacerbations and corticosteroid use. The committee acknowledged the economic implications but found them justifiable within the context of the treatment’s benefits.
Evidence Quality and Robustness
The evidence base is supported by multiple rigorous RCTs, although some methodological concerns and uncertainties in indirect comparisons exist. The overall quality of evidence is acceptable, warranting a moderate rating.
Uncertainty, Sensitivity, and Broader Impacts
There are notable uncertainties regarding the indirect treatment comparisons and the generalizability of the results across different patient populations. The committee expressed concerns about the robustness of the NMA results, which limits the confidence in broader impacts.
