A $20,000 lung-searing asthma treatment disappoints in sales

(Bloomberg) — Two years ago, Christi Thompson’s doctor put her under anesthesia, slipped an electrode-tipped catheter into her lungs, and used its hot end to sear the walls of her airways, thinning the enlarged muscle that cuts off a patient’s air during an asthma attack.

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Before, her asthma could get so bad she couldn’t speak, and she regularly ended up in the emergency room. Since the procedure, Thompson, 43, hasn’t been once.

Yet a medical breakthrough for Thompson has been a financial disappointment for Boston Scientific Corp. While the $20,000 procedure has backing from major medical groups, its sales are so small the company doesn’t report them. Boston Scientific executives initially projected it would be a billion-dollar market by 2020. The company paid $193.5 million in 2010 to acquire the technology, now called Alair, with the purchase of Asthmatx Inc.

One problem is getting reimbursed for the procedure, approved in the U.S. five years ago. Many of the country’s biggest insurers, including Cigna Corp. and Anthem Inc., say they’re concerned about Alair’s risks of complications and have declined to cover the therapy. There’s also the availability of inexpensive asthma drugs, and the potential for the disease to lessen or clear up on its own.

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Pressure is building on insurers after the American College of Allergy, Asthma and Immunology gave its support for the procedure, bronchial thermoplasty, earlier this month, joining six other health organizations. About 26 million Americans have asthma.

“The hurdles that are sometimes put in place of newer technologies are challenging and take a lot of time to clear,” said David Pierce, president of Boston Scientific’s endoscopy division. “We have additional work to convince more and more payers to come on board.”

Insurer review

A dozen insurers have begun covering the method. The largest is Health Care Service Corp. Cigna completed a review of the procedure Wednesday, saying the therapy needs more research even though its results are promising. Others will probably also wait for a long-term study of the technology.

“Bronchial thermoplasty is considered investigational and not medically necessary for the treatment of asthma,” said Jill Becher, an Anthem spokeswoman. “This procedure has real and significant complications and the ongoing concern is the relative safety as compared to the benefit.”

The most common complications are congestion that can feel like a severe asthma attack, bronchospasm and worsening of airway hyper-reactivity. The most feared is a punctured lung or bleeding. The procedure, which builds on a similar approach used to treat erratic heart rates, is done three times on different parts of the lung.