Canadian economic evaluation of budesonide-formoterol as maintenance and reliever treatment in patients with moderate to severe asthma.
OBJECTIVE
To compare the cost-effectiveness of budesonide-formoterol in a single inhaler used as both maintenance and reliever medication versus clinician-directed titration of salmeterol-fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.


METHODS
A Canadian economic evaluation was conducted based on the results of a large (n=2143), open-label, randomized, controlled effectiveness trial in which health resource use was prospectively collected. The primary outcome measurement was the time to the first severe exacerbation. Costs included direct medical costs (physician and emergency room visits, hospitalizations, asthma drug costs, etc) and productivity (absenteeism). The time horizon was one year, which corresponded to the duration of the clinical trial. Prices were obtained from 2005 Canadian sources. Both health care and societal perspectives were considered, and deterministic univariate sensitivity analyses were conducted.


RESULTS
In the clinical trial, budesonide-formoterol as maintenance and reliever treatment was superior to salmeterol-fluticasone with respect to the time to the first severe exacerbation, overall rate of exacerbations and use of as-needed reliever medication. The annualized rate of severe exacerbations was 0.24 events/patient in the budesonide-formoterol arm and 0.31 events/patient in the salmeterol-fluticasone arm (P=0.0025). From a health care perspective, the mean cost per patient-year was $1,315 in the budesonide-formoterol arm versus $1,541 in the salmeterol-fluticasone arm. From a societal perspective, the mean cost per patient-year was $1,538 in the budesonide-formoterol arm and $1,854 in the salmeterol-fluticasone arm. Budesonide-formoterol was dominant (more effective and less expensive) in the base case analysis from both perspectives. The results were robust under sensitivity testing.


CONCLUSIONS
The strategy that allows budesonide-formoterol to be used in a single inhaler as both maintenance and reliever medication proved to be more effective and less expensive than a strategy of clinician-directed titration of salmeterol-fluticasone with salbutamol as reliever therapy.
Miller
Elizabeth
E
Axia Research Inc., 181 Main Street West, Hamilton, Ontario, Canada. betsy@axiaresearch.com
Sears
Malcolm R
MR
McIvor
Andrew
A
Liovas
Anna
A
D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000730:Androstadienes / Q000008:administration & dosage / Q000191:economics; D001249:Asthma / Q000145:classification / Q000188:drug therapy* / Q000191:economics*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics*; D019819:Budesonide / Q000008:administration & dosage / Q000191:economics; D002170:Canada; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage / Q000191:economics; D005069:Evaluation Studies as Topic; D000068298:Fluticasone; D000068759:Formoterol Fumarate; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009330:Nebulizers and Vaporizers / Q000191:economics; D000068299:Salmeterol Xinafoate; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000730:Androstadienes; D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol; D000068759:Formoterol Fumarate
J Allergy Clin Immunol. 2001 Jan;107(1):3-8
11149982
Chest. 2004 Mar;125(3):1081-102
15006973
J R Coll Physicians Lond. 1993 Oct;27(4):387-90
8289159
CMAJ. 1996 Mar 15;154(6):821-31
8634960
Am Heart J. 2005 Mar;149(3):434-43
15864231
Eur Respir J. 2005 Nov;26(5):819-28
16264042
CMAJ. 2005 Sep 13;173(6 Suppl):S3-11
16157733