A real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma.
OBJECTIVE
To evaluate direct asthma-related costs in Swedish primary care in a real-life setting.


METHODS
12-month open-label study.


METHODS
Swedish primary care in a real-life setting.


METHODS
1776 patients with persistent asthma.


METHODS
Patients with persistent asthma were randomised to one of three treatments: a free adjustable combination of budesonide (100-400 microg/inhalation) and formoterol (4.5 or 9 microg/inhalation) via separate inhalers plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, two inhalations twice daily) plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, one inhalation twice daily or two inhalations once daily), for maintenance plus additional inhalations as needed. Doses depended on previous inhaled corticosteroid dose. Patients attended the clinic at 0, 1.5, and 12 months. Telephone interviews were conducted at 4, 6, 8, and 10 months.


METHODS
The primary endpoint was direct asthma-related healthcare costs.


RESULTS
Statistically significant reductions in annual direct costs per patient were observed with budesonide/formoterol maintenance and reliever therapy compared with the free adjustable combination of budesonide and formoterol (-13%, P<0.001) and fixed-dose budesonide/formoterol plus terbutaline (-20%, P<0.001). Time to first severe exacerbation did not differ significantly across treatment groups, with a mean reduction of 28% versus the free adjustable combination of budesonide and formoterol (P=0.076). Patients receiving budesonide/formoterol maintenance and reliever therapy used a significantly lower daily dose of budesonide compared with the conventional (P<0.001).


CONCLUSIONS
This study reports direct cost savings with budesonide/formoterol maintenance and reliever therapy compared with conventional treatment regimens with at least equivalent efficacy.
Ställberg
B
B
Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden. b.stallberg@salem.mail.telia.com
Ekström
T
T
Neij
F
F
Olsson
P
P
Skoogh
B-E
BE
Wennergren
G
G
Löfdahl
C-G
CG
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D019819:Budesonide / Q000008:administration & dosage* / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D000068759:Formoterol Fumarate; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013726:Terbutaline / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D013726:Terbutaline; D000068759:Formoterol Fumarate