Many people with severe asthma have uncontrolled disease and accumulate high lifetime doses of oral corticosteroids (OCS). Although biologic therapies reduce exacerbations and OCS use, current care often follows a failure-based approach to starting biologics (1). Severe asthma accounts for ~50% of all asthma costs, despite representing only 10% of the population (2,3). Emerging clinical evidence suggests that intervening earlier could yield better outcomes, yet the broader health economic impact on patients and the wider healthcare resource utilisation is not well quantified.
What we performed for this research
To explore the clinical and economic impact of starting biologics earlier, we developed a cost-consequence Markov cohort model. We compared earlier biologic initiation compared to “current practice” in the UK as a case-study, where eligibility typically results in biologic treatment at age 50. Inputs from the model were drawn from published and grey literature and refined through three workshops with five clinical experts. The model considered starting biologics 5, 10, 15, or 20 years earlier than current practice and outcomes of interest included mortality, exacerbations, health-care resource use (HCRU), cumulative OCS, quality-adjusted life years (QALYs), and healthcare costs, with medication costs not included.
What we found
Our results indicated that starting biologics 5 years earlier for a cohort of 54,121 patients (vs the current practice at age 50) results in:
- 1,975 fewer deaths, 157,700 fewer general practitioners (GP), emergency department and hospital visits, 18,000 QALYs gained, and £336 million saved in direct healthcare costs (attributable to exacerbations and OCS-related adverse events).
- On average, each patient had 1.91 g less cumulative OCS use over a lifetime.
Starting even earlier (20 years) delivers even larger gains
- Deaths avoided rose to ~3,100.
- There was a ~32% reduction in asthma exacerbations.
- There were 575,771 exacerbation-related GP visits averted.
Our results indicate that initiating biologics earlier can improve survival and quality of life while lowering HCRU in both primary and secondary care. The benefits are expected to extend to wider societal gains through improved work-related productivity and reduced absenteeism, extrapolated from another model, resulting in an additional ~£2 billion savings over 15 years within the 54,121 cohort (4).
Why this matters
Current biologic initiation is often triggered by repeated failure on standard care, therefore, patients can accrue substantial OCS exposure, elevating risks of type 2 diabetes mellitus, osteoporosis, and cardiovascular disease, and recurrent events such as glaucoma, cataracts, peptic ulcers, pneumonia, and adrenal complications. Earlier biologic use can help reduce cumulative OCS exposure and its associated risks, thereby delaying asthma progression and preventing avoidable HCRU.
The poster was presented at the European Respiratory Society (ERS) International Congress in Amsterdam, September 2025 and can be downloaded here.
Acknowledgements: This work was funded by AstraZeneca. The work was carried out independently by Aquarius Population Health.
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com.
References
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. Available from: www.ginasthma.org
- Blaiss, M. S., Castro, M., Chipps, B. E., et al. Ann Allergy Asthma Immunol. 2017 Dec;119(6):533-540. doi: 10.1016/j.anai.2017.09.058. Epub 2017 Nov 2.
- NHS England » Respiratory disease [Internet]. [cited 2024 Jan 24]. Available from: https://www.england.nhs.uk/ourwork/clinical-policy/respiratory-disease/
- Frontier Economics. Defining the size of the health innovation prize [Internet]. 2025. Available from: https://cdn.thehealthinnovationnetwork.co.uk/wp-content/uploads/2025/06/Defining-the-Size-of-the-Health-Innovation-Prize-report.pdf
Article by Erik Robinson, September 2025