Cost effectiveness of inhaled steroid withdrawal in outpatients with chronic obstructive pulmonary disease.
BACKGROUND
The evidence for the effectiveness and safety of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) is inconclusive. This study determined the cost effectiveness of withdrawing fluticasone propionate (FP) in outpatients with COPD.


METHODS
The cost effectiveness analysis was based on a randomised, placebo controlled FP withdrawal study. After a 4 month run in period on FP, patients were randomly assigned to continue FP 500 microg twice daily or to receive placebo for 6 months. A decision analytical model evaluated the 6 month incremental cost effectiveness of the ICS versus ICS withdrawal strategy. One way sensitivity analyses and a Monte Carlo simulation were performed to evaluate the robustness of the findings.


RESULTS
The average patient with COPD in the FP group generated 511 in direct medical costs, including 238 for FP. The cost of the placebo strategy was 456. The higher direct drug cost of 212 per patient for the FP strategy during the 6 month follow up period compared with the placebo group was partially offset by a lower exacerbation and hospital admission cost of 157. The 6 month incremental cost effectiveness of the FP strategy compared with placebo was 110 per exacerbation prevented and 1286 per hospital admission prevented.


CONCLUSIONS
Over a 6 month period, withdrawing FP in a pre-selected trial population of COPD patients led to absolute cost savings but with a higher rate of exacerbations and hospital admissions.
van der Palen
J
J
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands. vdpalen@euronet.nl
Monninkhof
E
E
van der Valk
P
P
Sullivan
S D
SD
Veenstra
D L
DL
D000280:Administration, Inhalation; D000730:Androstadienes / Q000008:administration & dosage* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D000068298:Fluticasone; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D012008:Recurrence; D028761:Withholding Treatment
D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone