Comparison of real-world healthcare resource utilization and costs among patients with hereditary angioedema on lanadelumab or berotralstat long-term prophylaxis

Aim: Hereditary angioedema (HAE) is a rare and chronic genetic condition. Lanadelumab and berotralstat, two plasma kallikrein inhibitors, have both been approved for long-term prophylaxis in patients with HAE; however, real-world data comparing costs and healthcare resource utilization (HCRU) are lacking. Materials & methods: This retrospective study used administrative healthcare insurance claims data (Merative™ MarketScan^® Commercial, Medicare and Early View Research Databases; 1 July 2017–31 July 2023) to identify patients with HAE who initiated lanadelumab or berotralstat and were persistent for ≥18 months or 6 months, respectively. Sex, baseline healthcare costs and baseline number of on-demand treatment/short-term prophylaxis medication claims were used to calculate covariate balancing propensity scores for inverse probability of treatment weighting. Following weighting, outcomes during the 6-month follow-up period in patients receiving berotralstat were compared with those during months 0–6, 7–12 and 13–18 in lanadelumab-treated patients. Results: Fifty-seven lanadelumab- and 32 berotralstat-treated patients were included. After weighting, more berotralstat-treated patients had an all-cause inpatient admission (berotralstat, 9.4%; lanadelumab, months 0–6, 4.0%, 7–12, 1.8%, months 13–18, 2.0%) and emergency room visit (berotralstat, 21.9%; lanadelumab, months 0–6, 14.0%, 7–12, 8.0%, months 13–18, 17.9%). Total HAE treatment costs were similar during months 0–6 (lanadelumab, $377,326 vs berotralstat, $373,010), but decreased in months 7–12 ($319,967) and 13–18 ($283,241) of lanadelumab. On-demand treatment/short-term prophylaxis costs were lower for lanadelumab across the three follow-up periods than for berotralstat during months 0–6 (berotralstat, $60,451; lanadelumab, months 0–6, $46,336, months 7–12, $37,578, months 13–18, $23,968). The proportion of lanadelumab-treated patients who reduced dosing frequency was 24.8% during months 7–12 and 21.6% during months 13–18. Conclusion: Patients with HAE initiating lanadelumab versus berotralstat may require less on-demand and supportive HAE treatments and incur lower treatment-related and total healthcare costs. The ability to reduce lanadelumab dosing frequency after an attack-free period may be key in treatment selection, given the combination of cost savings and lower healthcare resource utilization.