title: Cost effectiveness of budesonide/formoterol in a single inhaler for COPD compared with each monocomponent used alone.
abstract: OBJECTIVE
  To compare the healthcare costs and effects of budesonide/formoterol in a single inhaler with those of budesonide and formoterol monotherapies, and placebo, in a multinational study in patients with chronic obstructive pulmonary disease (COPD), National Heart, Lung and Blood Institute (NHLBI)/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV. Previous analysis of the clinical data from the study had shown that budesonide/formoterol was associated with better lung function and improved health-related QOL compared with the monocomponents or placebo and lower frequency of exacerbations compared with formoterol and placebo.
  
  
  METHODS
  Patients (n = 1022) were randomised to twice-daily treatment with two inhalations of budesonide/formoterol (160 microg/4.5 microg) in a single inhaler, budesonide 200 microg, formoterol 4.5 microg or placebo for 12 months. Data on medication and healthcare use were combined with Swedish unit cost data to estimate the total annual healthcare cost per patient from the Swedish healthcare payer perspective. Costs were valued in Swedish kronor (SEK) [2001 values] and converted to euros (SEK 1 = euro 0.11, 25th April 2003).
  
  
  RESULTS
  This evaluation estimated the total annual healthcare costs per patient to be numerically lower for budesonide/formoterol (euro 2518) than for budesonide (euro 3194), formoterol (euro 3653) or placebo (euro 3213). Cost-effectiveness acceptability curves suggest that budesonide/formoterol may be cost effective compared with formoterol, even if the decision maker is not willing to pay anything for the additional clinical effects, and that budesonide/formoterol is cost effective compared with placebo if a decision maker is willing to pay about euro 2 per day, per avoided exacerbation.
  
  
  CONCLUSIONS
  This economic analysis suggests that the clinical benefits of using budesonide/formoterol in a single inhaler are achieved at a numerically lower total healthcare cost than either monocomponent or placebo. Budesonide/formoterol in patients with severe COPD (GOLD stages III or IV) may be cost effective, from the healthcare provider perspective, compared with either monocomponent.
authors.affiliation: Department of Respiratory Medicine and Allergology, Lund University Hospital, S-22185 Lund, Sweden. claes-goran.lofdahl@lung.lu.se
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Löfdahl
authors.forename: Asa
authors.initials: A
authors.lastname: Ericsson
authors.forename: Klas
authors.initials: K
authors.lastname: Svensson
authors.forename: Emma
authors.initials: E
authors.lastname: Andreasson
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests
chemical_list: D001993:Bronchodilator Agents; D004338:Drug Combinations; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate