title: Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol: a retrospective matched observational study of real-world patients.
abstract: BACKGROUND
  Efficacy trials suggest that extra-fine particle beclometasone dipropionate-formoterol (efBDP-FOR) is comparable to fluticasone propionate-salmeterol (FP-SAL) in preventing asthma exacerbations at a clinically equivalent dosage. However, switching from FP-SAL to efBDP-FOR has not been evaluated in real-world asthma patients.
  
  
  OBJECTIVE
  The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR.
  
  
  METHODS
  A retrospective matched (1:3) observational study of 1,528 asthma patients aged 18-80 years from clinical practice databases was performed. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non-inferiority (at least equivalence) of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.
  
  
  RESULTS
  efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)). Switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean -130μg/day FP equivalents; p<0.001). It also reduced mean asthma-related healthcare costs by £93.63/patient/year (p<0.001).
  
  
  CONCLUSIONS
  Asthma patients may be switched from FP-SAL to efBDP-FOR at an equivalent or lower ICS dosage with no reduction in clinical effectiveness but a significant reduction in cost.
authors.affiliation: Academic Centre of Primary Care, University of Aberdeen, UK • Research in Real Life Ltd, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Iain
authors.initials: I
authors.lastname: Small
authors.forename: John
authors.initials: J
authors.lastname: Haughney
authors.forename: Dermot
authors.initials: D
authors.lastname: Ryan
authors.forename: Kevin
authors.initials: K
authors.lastname: Gruffydd-Jones
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.forename: Tim
authors.initials: T
authors.lastname: Harris
authors.forename: Annie
authors.initials: A
authors.lastname: Burden
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brockman
authors.forename: Christine
authors.initials: C
authors.lastname: King
authors.forename: Alberto
authors.initials: A
authors.lastname: Papi
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001507:Beclomethasone / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D057915:Drug Substitution / Q000191:economics; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D000068759:Formoterol Fumarate; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D004338:Drug Combinations; D004983:Ethanolamines; D000068297:Fluticasone-Salmeterol Drug Combination; D001507:Beclomethasone; D000420:Albuterol; D000068759:Formoterol Fumarate