Cost-effectiveness of inhaled beta-agonists v. oral salbutamol in asthma: a randomized double-blind cross-over study.
BACKGROUND
Oral beta-stimulants are widely used in the management of chronic asthma in India, in spite of evidence suggesting the superiority of inhaled medication in achieving maximum bronchodilatation. An economic evaluation was performed in a randomized double-blind cross-over trial to evaluate the role of adjuvant oral beta-stimulants in the treatment of asthma.


METHODS
Patients who had seasonal or perennial asthma and were using metered dose inhalers for control of symptoms were randomly selected for the study. They received either 4 mg of oral salbutamol or placebo as adjuvant treatment. During the study they controlled their symptoms by adjusting the dose of the inhaler medication. A cost minimization technique was used to assess the economic impact of this intervention in the treatment and control periods. A sensitivity analysis was performed to assess the robustness of the conclusions.


RESULTS
The mean cost was significantly greater in the treatment period and a patient lost approximately Rs 20 per month (CI: 13 to 27; p = 0.001) as a result of the adjuvant treatment. There was no significant difference in the quality of life or peak expiratory flow rate during the two periods. The patients also noted mild but significantly increased tremors (p = 0.01) and palpitations (p = 0.001) during the treatment period. There was no treatment-to-period interaction.


CONCLUSIONS
Adjuvant oral beta-agonists do not improve the quality of life or bronchodilatation in asthmatics using an inhaled beta-agonist for control of symptoms.
Thomas
K
K
Department of Medicine and Clinical Epidemiology, Christian Medical College, Vellore, Tamil Nadu, India.
Peter
J V
JV
Cherian
A M
AM
Guyatt
G
G
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000191:economics; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage* / Q000191:economics; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013726:Terbutaline / Q000008:administration & dosage* / Q000191:economics
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D013726:Terbutaline; D000420:Albuterol