The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada (original) (raw)
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Respiratory Medicine, 2004
Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose, adding a long-acting b 2-agonist, or both. This study assessed the cost-effectiveness of these options. Patients aged X12 years with mild-to-moderate persistent asthma (n ¼ 1272) were randomised to twice-daily, double-blind treatment with budesonide 100 mg, budesonide 100 mg plus formoterol 4.5 mg, budesonide 200 mg, or budesonide 200 mg plus formoterol 4.5 mg for 12 months. Clinical variables included lung function, number of symptom-free days and number of severe exacerbations. Data on medication use, hospitalisation, visits to health professionals and time off work due to asthma were combined with Swedish unit cost data (1999) to estimate the mean annual cost per patient. Budesonide 200 mg plus formoterol 4.5 mg had the greatest efficacy and effectiveness. Budesonide 200 mg plus formoterol 4.5 mg was both more effective and less costly than budesonide 100 mg plus formoterol 4.5 mg, so a cost-effectiveness ratio was not calculated for this comparison. The cost-effectiveness ratio for budesonide 200 mg plus formoterol 4.5 mg compared with budesonide 200 mg alone was SEK 21 per symptom-free days gained. The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost.
Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy
Allergy, 2007
Clinical guidelines suggest that an appropriate treatment paradigm for persistent asthma uncontrolled by inhaled corticosteroids (ICS) alone, is maintenance therapy with an ICS/long-acting b 2 -agonist (LABA) combination administered twice daily, plus a short-acting b 2 -agonist (SABA) as needed for symptom relief (1, 2). The two ICS/LABA combination inhalers currently available -budesonide/ formoterol (Symbicort Ò ; AstraZeneca, Lund, Sweden) and salmeterol/fluticasone (Seretide TM ; GlaxoSmithKline, Brentford, UK) -are effective in patients with persistent asthma that is uncontrolled by ICS alone (3-7).
A budget impact analysis of budesonide/formoterol in patients with mild asthma in Egypt
Journal of Medical Economics, 2019
Background: The aim of this study is to estimate the budget impact of budesonide/formoterol fixed dose combination (FDC) vs salbutamol, both used as needed, in mild asthma patients, from the perspective of the Health Insurance Organization (HIO). Methods: A static budget impact model was developed to assess the impact of budesonide/formoterol FDC entry on HIO budget over a 3-year period in Egyptian settings. Direct medical costs, including the costs of asthma medications, exacerbations, and management of side-effects, were obtained from HIO cost data. Population data were obtained from the World Bank and supplemented with local studies, and the rates of exacerbations, adverse effects, and number of sick leave days were elicited from the SYGMA 1 trial. Scenario analyses from a societal perspective and deterministic sensitivity analyses were conducted. Results: The total costs (drug and non-drug costs) for managing mild asthma patients from the HIO perspective were estimated to be EGP8.563 billion before budesonide/formoterol entry compared to EGP5.525 billion post-entry, leading to a total budget savings of EGP3.038 billion after 3 years. This total budget saving included an increase in drug costs (EGP104 million) and a decrease in non-drug costs (EGP3.143 billion). Drug costs were higher in the budesonide/formoterol group than in the salbutamol group, but this cost was offset by reductions in non-drug costs, resulting in a reduction in the total costs of healthcare resources. At the societal level, the total budget savings after including the indirect costs was expected to be EGP5.976 billion after 3 years of budesonide/formoterol entry. Conclusion: Budesonide/formoterol in mild asthma instead of salbutamol produces better patient outcomes and decreases total costs, with increases in drug cost offset by reductions in non-drug costs due to fewer exacerbations. Budesonide/formoterol is a budget saving option for guideline-directed treatment, from the economic perspective of the payer and the health perspective of the patient.
Drugs & Therapy Perspectives, 2021
Budesonide/formoterol (Symbicort®) as needed (PRN) is effective for the prevention of severe exacerbations in mild asthma. This economic model evaluated the cost effectiveness of budesonide/formoterol PRN versus (1) a short-acting β2-agonist (SABA) PRN and (2) maintenance budesonide plus SABA PRN for mild asthma in Malaysia. A decision analytical model was developed to evaluate the downstream economic consequences of the comparators from the payer’s perspective (i.e. Ministry of Health, Malaysia) with a fixed time horizon of 1 year, and no discounting was applied. Data were derived from published clinical trials (i.e. SYGMA 1, SYGMA 2, and Novel START), the latest Malaysian resources, and an expert panel. The incremental cost-effectiveness ratio (ICER) per severe exacerbation avoided was determined. Sensitivity and scenario analyses were conducted to examine the robustness of the model. Treatment with budesonide/formoterol PRN (Malaysian ringgit [RM]773.39) had a lower total annual ...
Current Medical Research and Opinion, 2006
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 study examined three strategies for the treatment of asthma: budesonide/formoterol 160/4.5 microgram once daily plus additional doses as needed (1xSMART); budesonide/formoterol 160/4.5 microgram twice daily plus additional doses as needed (2xSMART); budesonide/formoterol two doses of 160/4.5 microgram twice daily plus formoterol 4.5 microgram as needed (2x2FIX+F). Children aged 6 to 11 years old used the 80/4.5 microgram formulation of budesonide/formoterol with the same number of doses in each treatment strategy as the older patients. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population comprised patients from the age of 6 years with asthma. The article stipulated that the patients should be not well-controlled on maintenance therapy with inhaled corticosteroids (ICS) or should be well-controlled on a combination of ICS and long-acting inhaled beta2-antagonist. Patients should present a forced expiratory volume in 1 second of at least 60% of predicted normal after inhalation of a short-acting inhaled beta2-antagonist. Patients with a smoking history of more than 10 pack-years were excluded. Setting The setting was primary or secondary care in an outpatient context. The economic study was carried out in Sweden. Dates to which data relate The dates when the effectiveness and resource use data were gathered were not reported. The price year was 2004. Link between effectiveness and cost data The costing was carried out prospectively on the same sample of patients that provided the effectiveness data.
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
Cost–utility of inhaled corticosteroids in patients with moderate-to-severe asthma
Expert Review of Pharmacoeconomics & Outcomes Research, 2004
Different inhaled corticosteroids can be used to treat asthma but their relative efficacy on quality of life and relative economic impact are mostly unknown. A decision model compared the cost-utility of beclomethasone, beclomethasone-extrafine, fluticasone and budesonide in adult patients with either moderate or severe persistent asthma. The patients' health state was described by the Asthma Symptom Utility Index. Patients' consumption of healthcare resources, according to the health state, was elicited by a Delphi Panel. Within 2 months, beclomethasone-extrafine prolonged quality-adjusted life by 0.5-2.3 days, as compared with the other inhaled corticosteroids, and reduced asthma-related per patient costs by €12-67.