Asthma is a chronic condition with characteristics that make it an ideal target for interventions used within disease state management in managed care settings. It affects a substantial population of patients and imposes an increasingly significant global societal burden. Despite the availability of many asthma medications and easily accessed publications providing step-wise guidance for asthma management, there are still patients whose condition is not well controlled. Hence, there is a continuing need for unique treatment options. Omalizumab is a subcutaneously administered monoclonal anti-IgE antibody that reduces free IgE concentrations and promotes down-regulation of IgE receptors on basophils. This relatively new pharmacologic intervention has been shown to reduce inhaled corticosteroid (ICS) and rescue medication requirements, and improve asthma control and quality of life in patients with moderate to severe allergic asthma with disease poorly controlled by ICSs. However, because of its high cost relative to other asthma drug therapies, health plans/payers must ensure that criteria for its use are clearly identified so as to target patients who will most likely benefit from such therapy. Omalizumab may need to be restricted to asthma patients with severe persistent allergy who are categorized as `high risk' (e.g. patients with a recent history of frequent intubations, emergency room visits, overnight hospitalizations, or intensive care unit admissions for asthma exacerbations) who remain symptomatic despite appropriate maximal maintenance therapy for the severity of their disease. If restricted to this narrowly defined population of patients with allergic asthma, cost-of-care studies suggest that the high cost of this product could be offset by savings resulting from the less frequent use of high-intensity medical services for asthma exacerbations.
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