Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 μ g twice daily and budesonide 800 μ g twice daily in the treatment of adults and adolescents with asthma (original) (raw)

Cost-Effectiveness Analysis of Salmeterol/Fluticasone Propionate 50/100??g vs Fluticasone Propionate 100??g in Adults and Adolescents with Asthma III: Results

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.

Cost-Effectiveness Analyses of Salmeterol/Fluticasone Propionate Combination Product and Fluticasone Propionate in Patients with Asthma I: Introduction and Overview

PharmacoEconomics, 1999

When a new drug therapy is introduced, it is important to consider the economic impact of the treatment. This is particularly relevant for a chronic disease such as asthma. Despite an increased understanding of the physiology of asthma, this condition remains an important cause of morbidity and mortality in many countries and places a large financial burden on healthcare systems. An economic analysis was performed to determine the cost effectiveness of 3 strengths of a new salmeterol/fluticasone propionate combination product (SFC): 50/100, 50/250 and 50/500μg twice daily relative to the equivalent dose of fluticasone propionate (FP) alone (100, 250 or 500μg twice daily, respectively). The economic analysis was performed using 12-week data from 3 randomised controlled clinical trials in adults and adolescents with asthma. The analysis was conducted from the perspective of the Swedish healthcare system and only direct costs were considered. Data from daily diaries showed that all 3 strengths of SFC were associated with a significantly higher proportion of successfully treated weeks (defined as a ≥5% improvement in predicted peak expiratory flow, compared with baseline) than FP alone. The cost per successfully treated week was lower for all 3 strengths of the combination product than for the equivalent dose of FP alone [SEK150.9 to 365.1 ($US18.31 to 44.30) vs SEK169.0 to 487.8 ($US20.50 to 59.18)], despite higher drug costs associated with the former. The incremental cost-effectiveness ratios showed that the costs to achieve an additional successfully treated week with SFC were SEK133.4 ($US16.18), SEK12.6 ($US1.53) and SEK192.1 ($US23.31) for the 50/100, 50/250 and 50/500μg strengths, respectively. Sensitivity analysis indicated that these results were robust over a wide range of assumptions. Thus, in the Swedish healthcare setting

Cost analysis of the use of inhaled corticosteroids in the treatment of asthma: a 1-year follow-up

Respiratory Medicine, 2001

A retrospective cohort using pharmacy and medical claims was analysed to determine whether the di¡erences in e⁄cacy of various inhaled corticosteroids demonstrated in clinical trials lead to di¡erences in costs of care observed in clinical practice. Subjects that had an ICD-9 (493.XX) code for asthma and a new pharmacy claim for inhaled £uticasone propionate 44 mcg (FP), beclomethasone dipropionate (BDP), triamcinolone acetonide (TAA), budesonide (BUD) or £unisolide (FLU) were identi¢ed and followed for 12 months. Annual asthma care charges (pharmacy and medical) over the 12-month observation period were signi¢cantly (Po0?03) higher in patients treated with BDP,TAA, BUD and FLU compared to FP, 24%, 27%, 34% and 45% respectively.In addition, patients treated with BDP,TAA, and FLU were associated with signi¢cantly (P 0?005) higher total healthcare (asthma þ non-asthma) charges compared to patients on FP, 53%, 46% and 39% respectively. Asthma care and total healthcare charges remained lower for FP after including FP110 mcg and excluding patients who were extreme cost outliers (72 SD from the mean) in a univariate sensitivity analysis.This analysis supports recent randomized control trials that FP o¡ers a superior e⁄cacy pro¢le at lower asthma care as well as total healthcare charges compared to other inhaled corticosteroids.

Cost-effectiveness of asthma therapy

Official journal of the South African Academy of Family Practice/Primary Care

An important management strategy in asthma is the application of a cost-effectiveness review to the selected management principles. Efficacy, in the clinical trial setting, is the first determinant of effectiveness. However, in comparing the cost- effectiveness of two or more therapeutic strategies or drugs the determinants of cost-effectiveness may require more than the simple comparison of Rand value and clinical efficacy end-points. The Rand value of a successful outcome is vital. One of the main goals of long-term asthma management is to avoid asthma-related hospital admissions. An effective asthma education programme can resolve most, if not all of the shortcomings in asthma care. In addition, adherence to guideline recommendations would result in a a decrease in unnecessary and costly (cost-ineffective) therapies. Many asthmatics in South Africa are not being treated according to local or international guideline recommendations and lastly adherence is a serious problem in asth...

Cost-Effectiveness of Once-Daily, Single-Inhaler Indacaterol Acetate/ Glycopyrronium Bromide/ Mometasone Furoate in Patients with Uncontrolled Moderate-to-Severe Asthma in Canada

ClinicoEconomics and Outcomes Research

Purpose: We evaluated the cost-effectiveness of high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160 μg, once daily) compared with high-dose salmeterol/fluticasone (SAL/FLU; 50/500 µg, twice daily)+tiotropium (TIO; 5 µg, once daily) (SAL/FLU+TIO) and with high-dose SAL/FLU (50/500 µg, twice daily) for the treatment of inadequately controlled moderate-to-severe asthma. Patients and Methods: A Markov model estimated the incremental cost-effectiveness ratio of treatment with high-dose IND/GLY/MF compared with SAL/FLU+TIO and high-dose IND/GLY/MF compared with SAL/FLU. The model included three health states (day-today symptoms without exacerbations, day-today symptoms with exacerbations, and death) with a 4-week cycle length. A lifetime time horizon was used. Exacerbation rates and utility values were derived from ARGON and IRIDIUM clinical trials. Canadian dollars

Economic Impact of Asthma Therapy With Fluticasone Propionate, Montelukast, or Zafirlukast In a Managed Care Population

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.

Perspective on the Budgetary Impact of FP/FORM pMDI on Treatment and Management of Exacerbation in Moderate-to-Severe Asthma Patients in Singapore

ClinicoEconomics and Outcomes Research, 2020

Purpose: Reducing the risk of exacerbation is a long-term goal of managing moderate-tosevere asthma. The use of fluticasone propionate/formoterol fumarate dihydrate (FP/FORM) pressurized metered-dose (pMDI, Flutiform ®), a type of inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) fixed-dose combination, has been associated with lower oral corticosteroid-requiring exacerbation rates than other ICS/LABA fixed-dose combinations, fluticasone propionate/salmeterol xinafoate (FP/SAL) and budesonide/formoterol fumarate (BUD/FORM). This study presents the first budget impact analysis of drug and exacerbation management cost savings associated with the increased access to FP/FORM compared to the currently available ICS/LABAs for treating moderate-to-severe asthma in Singapore. Patients and Methods: A budget impact model showed changes to annual drug and exacerbation costs over 5 years for patients with moderate-to-severe asthma in Singapore, following the inclusion of FP/FORM on a government subsidy list. The eligible patient population was identified based on national statistics data. Different treatment costs pertaining to the population were applied according to the usage data (IQVIA Singapore National Sales Data) for different scenarios. Drug costs were obtained from public-sector hospitals. Exacerbation management costs were obtained from literature searches. Results: The analysis showed that increased access to FP/FORM as a result of switching from FP/SAL could help achieve drug (S$1,042,289) and exacerbation management (S 223,550)costsavingsover5years.InthescenariowherepatientsswitchedfromBUD/FORM,greaterdrug(S223,550) cost savings over 5 years. In the scenario where patients switched from BUD/ FORM, greater drug (S223,550)costsavingsover5years.InthescenariowherepatientsswitchedfromBUD/FORM,greaterdrug(S2,572,797) and exacerbation management (S$256,781) cost savings were observed over 5 years. Conclusion: The analysis provides a perspective that the increased access to FP/FORM could help achieve drug and exacerbation cost savings for the treatment of moderate-tosevere asthma.

Cost-Utility Analysis of the Inhaled Steroids Available in a Developing Country for the Management of Pediatric Patients with Persistent Asthma

Journal of Asthma, 2013

Introduction. The choice among the different treatments available can have a great impact on the costs of asthma, Objectives. The objective of this study was to estimate the incremental cost-utility ratio of three inhaled corticosteroids (ICs): budesonide (BUD), fluticasone propionate (FP), and ciclesonide, compared to beclomethasone dipropionate (BDP) (the only IC included in the Compulsory Health Insurance Plan of Colombia), Methods. A Markov-type model was developed to estimate costs and health outcomes of a simulated cohort of patients less than 18 years of age with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were 15 obtained from a hospital´s bills and from the national manual of drug prices. The study assumed the perspective of the national healthcare in Colombia. The main outcome was the variable "quality-adjusted life years" (QALY), Results. While treatment with BDP was associated with the lowest cost (£106.16 average cost per patient during 12 months), treatment with FP resulted in the greatest gain in QUALYs (0.9325 QALYs). FP was associated with a greater gain in QALYs compared to BUD and ciclesonide (0.9325 vs. 0.8999 and 0.9051 QALYs, respectively) at lower costs (£231.19 vs. £309.27 and £270.15, respectively), thus leading to dominance. The incremental cost-utility ratio of FP compared to BDP was 20 £19,835.28 per QALY, Conclusions. BDP is the most cost-effective therapy for treating pediatric patients with persistent asthma when willingness to pay (WTP) is less than £21,129.22/QALY, otherwise, FP is the most cost-effective therapy.