Cost effectiveness of leukotriene receptor antagonists versus inhaled corticosteroids for initial asthma controller therapy: a pragmatic trial.
BACKGROUND
Information is lacking on the relative effectiveness and cost effectiveness--in a primary-care setting--of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy.


OBJECTIVE
To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy.


METHODS
An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12-80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n = 326) were randomly assigned to LTRAs (n = 162) or ICS (n = 164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives.


RESULTS
Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at pounds sterling 711 versus pounds sterling 433 for the ICS group (adjusted difference pounds sterling 204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of pounds sterling 30,000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives.


CONCLUSIONS
There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy.


BACKGROUND
UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
Wilson
Edward C F
EC
Faculty of Health, University of East Anglia, Norwich, UK. ed.wilson@uea.ac.uk
Sims
Erika J
EJ
Musgrave
Stanley D
SD
Shepstone
Lee
L
Blyth
Annie
A
Murdoch
Jamie
J
Mugford
H Miranda
HM
Juniper
Elizabeth F
EF
Ayres
Jon G
JG
Wolfe
Stephanie
S
Freeman
Daryl
D
Gilbert
Richard F T
RF
Harvey
Ian
I
Hillyer
Elizabeth V
EV
Price
David
D
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D020024:Leukotriene Antagonists