Cost-Effectiveness Analyses of Salmeterol/Fluticasone Propionate Combination Product and Fluticasone Propionate in Patients with Asthma I: Introduction and Overview (original) (raw)
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PharmacoEconomics, 1999
Methods: An economic analysis was performed using data from a 12-week randomised controlled trial to determine the cost effectiveness of a salmeterol/ fluticasone propionate combination product (SFC) 50/100μg twice daily (n = 86) relative to fluticasone propionate (FP) 100μg twice daily (n = 85) in adults and adolescents with asthma. The analysis was conducted from the perspective of the Swedish healthcare system. Results: SFC was associated with a significantly higher proportion of successfully treated weeks (defined as a week with a mean improvement in morning peak expiratory flow of ≥5% compared with predicted baseline values) than FP alone (65 vs 33%; p < 0.00001). Although there were trends in favour of SFC, there were no significant differences between treatments in the proportions of symptom-free and episode-free days. The cost per successfully treated week was lower for the combination product than for FP [SEK151 ($US18.30) vs SEK169 ($US20.50)], despite higher drug costs associated with the former, indicating that, on average, improvements in lung function were achieved at a lower average cost with the combination product than with FP alone. The incremental cost-effectiveness ratio revealed that the cost to achieve an additional successfully treated week with SFC was an additional SEK133.4 ($US16.18) per week. These results were robust over a range of assumptions on sensitivity analysis. Conclusions: In summary, SFC 50/100μg resulted in significant improvements in lung function compared with FP 100μg alone. These additional benefits were achieved for a modest increase in cost, suggesting that SFC 50/100μg was more cost effective than FP 100μg alone in patients with asthma.
Respiratory Medicine, 2000
Objective: To evaluate the cost-utility of the treatment with a long acting beta-agonist (LABA) and inhaled corticosteroid (ICS) combination inhaler [salmeterol xinafoate (SAL)/fluticasone propionate (FP) combination inhaler (SFC) (Advair â )] to continuing on current ICS dose (no ICS dose change) or increased ICS dose [fluticasone propionate (FP)] in patients with uncontrolled asthma in Canada. Methods: A cost-utility analysis was conducted from a Canadian public healthcare perspective with a one year time horizon. In the no FP dose change scenarios, remaining on daily low (FP 100 ug BID) or medium (FP 200e250 ug BID) or high dose (FP 500 ug BID) was considered. In the increased FP dose scenarios, doubling the FP dose from low to medium dose and from medium to high dose regimens were considered. A decision model was developed with two health states: "symptom free" or "with symptoms". Clinical efficacy was based on a meta-analysis of relevant randomized controlled trials. Over the one year time horizon the percentage with symptom free days (SFD) was used as the measure of differential treatment scenario effectiveness. Drug costs and non-drug costs were incorporated into the analysis. Utilities, derived from EQ5D scores and health services resource use based on patient diaries for 'symptom free' and 'with symptoms' were based on regression analyses of individual patient data from the Gaining Optimal Asthma controL (GOAL) trial. Costs were assessed by assigning unit cost for each * Corresponding author. GlaxoSmithKline Canada, 7333 Mississauga Rd, Mississauga, ON L5N 6L4, Canada. Tel.: þ1 905 814 3556; fax: þ1 905 819 3099. E-mail address: Afisi.S.Ismaila@gsk.com (A.S. Ismaila). Respiratory Medicine (2014) 108, 1292e1302 health services resource use for each patient. The incremental cost-utility ratios (ICUR) for SFC vs no FP dose change or increased FP dose were estimated using descriptive statistics. Uncertainty was assessed by deterministic and probabilistic sensitivity analysis (PSA). Results: Over one year, SFC resulted in an incremental cost per patient of 544e544e544e655 compared to no FP dose change and 47e47e47e380 per year compared to increased FP dose. SFC results in incremental QALYs per patient of 0.0100e0.0149 compared to no FP dose change and 0.0136e0.0152 compared to increased FP dose. The one year ICURs were 43,000to43,000 to 43,000to54,400 per QALY gained for SFC compared to no FP dose change and 25,000to25,000 to 25,000to3500 per QALY gained compared to increased FP dose scenarios. The probability of SFC being costeffective at $50,000 per QALY gained was greater than 75% compared to increased FP dose scenarios and compared to no dose change for patients on low or medium dose FP. The results were robust to changes in assumptions within the model. Conclusion: In Canadian patients with inadequately controlled asthma on FP, it is costeffective to use SFC for patients 12 years and over compared to doubling their FP dose. It is also cost-effective to use SFC for patients on low or medium dose FP compared to remaining on the current FP dose in patients with uncontrolled asthma. ª
Background: Asthma is a chronic disease characterized by acute symptomatic episodes with variable severity and duration. Pharmacological asthma management aims to achieve and maintain control without side effects, thus improving quality of life and reducing the economic impact. Recently, a clinical trial showed the non-inferiority of beclomethasone/formoterol (BDP/F) versus fluticasone propionate/salmeterol (FP/S) in adults with moderate to severe persistent asthma. However, this study did not provide evidence on costs and did not quantify quality-of-life parameters. Objective: The objective of the present study was to assess the cost effectiveness and cost utility of BDP/F versus FP/S in patients with moderate to severe asthma from the perspective of the Italian National Health Service (NHS). Methods: A Markov model (MM) was used, with five health states for the different levels of asthma control: successful control, sub-optimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. Model data were derived from the ICAT SE study and from expert panels. Three outcomes were considered: time spent in successful control state, costs and quality-adjusted life-years (QALYs). Results: The model shows that BDP/F treatment led to a slight increase of weeks in successful control compared with FP/S, with a lower cost. The probabilistic sensitivity analysis highlights that in 64% and 68% of the Monte Carlo simulations, BDP/F outperformed FP/S in terms of weeks in successful control and QALYs. Considering the expected cost of the two strategies, in 90% of simulations BDP/F was the least expensive choice. In particular, BDP/F was
International journal of chronic obstructive pulmonary disease, 2010
To estimate the cost-effectiveness of fluticasone propionate-salmeterol combination (FSC) compared to salmeterol for maintenance therapy in severe chronic obstructive pulmonary disease (COPD). Pooled economic analysis. We performed an economic analysis of pooled data from two randomized clinical trials (combined N = 1554) that evaluated the effect of maintenance therapy with FSC (250/50 microg twice daily) or salmeterol (50 microg twice daily) on exacerbation rates in patients with severe COPD. We calculated exacerbation rates and applied standardized costs to exacerbation-related health care utilization reported in the trials (office, urgent care, and emergency department visits; hospitalizations; and oral corticosteroids and antibiotics) to determine cost differences between FSC and salmeterol treatment outcomes. Annual rates of any exacerbation and moderate/severe exacerbation were lower in the FSC group than the salmeterol group (4.91 vs 5.78 and 1.32 vs 2.00 respectively, both ...
Multidisciplinary Respiratory Medicine, 2016
Background: Asthma is a disease with high cost for the National Health Service. Two of the most recent LABA/ICS combinations for persistent bronchial asthma are Beclomethasone dipropionate/Formoterol (B/F) delivered via the Nexthaler device and Fluticasone furoate/Vilanterol (F/V) delivered via the Ellipta device. No comparison has been carried out yet in terms of cost analysis in asthma, to our knowledge. Aim of the present monocentric, observational, retrospective study was to calculate and compare the costs of mild-to-moderate asthma patients assuming B/F 100/6 μg b.i.d. to those of patients assuming F/V 92/22 μg once-a-day over a 12-week treatment period from the Italian National Health Service perspective. Methods: Data were obtained automatically and anonymously from the institutional database of the Lung Unit of the Specialist Medical Centre (CEMS), Verona, Italy, UNI EN ISO 9001-2008 validated. FEV 1 values, number of relapses, healthcare resources as hospitalizations due to asthma relapses, days of hospitalization, general practitioner (GP), specialist visits, and days of inactivity, were recorded over the study period together with the use of extra medications (systemic steroids and antibiotics). In order to compare the outcomes achieved in both groups, the propensity score matching method was used in STATA, and statistical significance was accepted for p < 0.05. Results: Clinical data of 77 patients treated with B/F b.i.d (Group A) and of 40 patients treated with F/V 92/22 μg once-a-day (Group B) were selected. The PS-matching process, designed as matching on the baseline covariates, gender, age, FEV 1 and comorbidities, returned a cohort of 40 group A patients of the entire cohort matched with 40 patients of group B, fully comparable for demographics and clinical characteristics. In the PS-matched cohort, the mean (±SE) number of relapses per patient during the follow-up was 0.53 (±0.12) in group A and 0.28 (±0.07) in group B. In group A, n = 25 (62.50 %), n = 9 (22.50 %), and n = 6 (15 %) patients had 0, 1, 2 relapses, respectively. In group B, n = 29 (72.50 %), and n = 11 (27.50 %) had 0 and 1 relapse, respectively. Over the study period, the average number of hospitalizations per patient was 0.15 (±0.06), with 0.28 (±0.12) days of hospitalization in group A, and 0.08 (±0.04) with 0.08 (±0.04) days of hospitalization in group B, respectively. The difference between the two groups in terms of FEV 1 (L) improvement vs baseline was 0.11 in favour of group B (p = 0.007). When results were compared, the improvement in lung function obtained in group B proved significantly higher both in terms of absolute FEV 1 and of FEV 1 % predicted. The mean (±SE) cost of hospitalizations per patient was € 345.30 (±133.23) in group A and € 172.65 (±98.18) in group B, respectively, with a mean not significant difference of-€ 172.65 in favour of group B (p = 0.9). In particular, the
Cost-effectiveness of fluticasone propionate/salmeterol (500/50μg) in the treatment of COPD
Respiratory Medicine, 2009
Objective: We examine the lifetime cost-effectiveness of treatment with fluticasone propionate/salmeterol (500/50 mg) compared with no maintenance treatment in COPD in the US. Methods: A decision-analytic model was developed to estimate lifetime costs and outcomes associated with fluticasone propionate/salmeterol 500/50 mg treatment, salmeterol 50 mg, and fluticasone propionate 500 mg compared to no maintenance treatment in treating COPD from a thirdparty US payer perspective. The patient population was similar to that of the TORCH clinical trial. Model structure and inputs were obtained from published literature and clinical trial data. All costs are presented in 2006 US dollars. Outcomes included cost per life year (LY) saved and cost per quality-adjusted life year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness.
ClinicoEconomics and Outcomes Research, 2018
Objectives: The Salford Lung Study in Chronic Obstructive Pulmonary Disease (SLS COPD) is a 12-month, open-label randomized clinical trial comparing clinical effectiveness and safety of initiating once-daily fluticasone furoate/vilanterol (FF/VI) 92/22 mcg with continuing usual care (UC) in patients with COPD followed in primary care in the UK. The objective of this analysis is to estimate the economic impact of these results when applied to Spain. Materials and methods: An Excel-based cost-consequence model with a one-year time horizon was populated with SLS COPD results, adopting the Spanish National Health System (NHS) perspective. Patients analyzed were diagnosed COPD patients ≥40 years old, currently managed with maintenance treatment and with a history of exacerbations (total number estimated from Spanish data). Mean least squares annual rates of moderate/severe exacerbations after 1 year for the intention-to-treat population from SLS COPD were included in the model (1.50 [FF/VI] and 1.64 [UC]); serious adverse events were excluded from the analysis as no differences between treatment arms were found. Medication and exacerbation management costs in euros were estimated from Spanish public sources for 2016. Model base-case analysis assumed an increased usage of FF/VI from 4% to 10% within 1 year, and a 100% proportion of days covered with study medications. Deterministic sensitivity analyses were performed for mitigating uncertainty. Results: At base case, within 50,522 COPD patients analyzed, substitution of UC with FF/ VI 92/22 mcg was associated with reduced medication and exacerbation management costs, leading to potential total annual savings of €353,623. Deterministic sensitivity results ranged from €218,333 up to €1,532,366 potential cost savings associated with FF/VI, showing the robustness of base-case results. Conclusion: The decreased rate of exacerbations with FF/VI 92/22 mcg compared with UC observed in SLS COPD could be translated into potential health care savings for the Spanish NHS. These results may be useful to inform decision-making processes.
Pharmacotherapy, 2002
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The health technology was controller therapy for patients with asthma. The comparators were inhaled corticosteroids and leukotriene modifiers in real world clinical practice. The authors compared fluticasone propionate (44 or 110 microg) with oral zafirlukast (20 mg) and montelukast (5 or 10 mg). Type of intervention Primary prevention. Economic study type Cost-effectiveness analysis. Study population The study population included patients that had a primary ICD-9-CM code (493.xxx) for asthma that occurred any time in the database. The patients were aged 4 years or older and had to have been enrolled in the plan continuously for at least 18 months, that is, 9 months before (preindex) and 9 months after (postindex) the first initial prescription. During the initial 9 months, the patients were required not to have had an inhaled corticosteroid or an oral leukotriene modifier. Patients were excluded if they had pharmacy claims for several drugs of interest, they were younger than 4 years or older than 45 years, and if they had had one or more prescriptions for ipratropium bromide during the study period. Patients with a diagnosis of cystic fibrosis or chronic obstructive pulmonary disease were also excluded. Setting The setting was secondary care. The economic study was carried out in the USA. Dates to which data relate The effectiveness data were collected from 1 July 1997 to 30 June 1999. The dates to which the costs referred were unclear, although they appear to have been the same as those for the effectiveness data. The price year was not reported. Source of effectiveness data The effectiveness data were derived from a single study. Link between effectiveness and cost data It was not stated clearly whether the costing was undertaken on the same sample as that used in the effectiveness study. However, it appears that the costing has been undertaken retrospectively on the same sample.