title: Outcomes and costs of treating chronic obstructive pulmonary disease with inhaled fixed combinations: the Italian perspective of the PATHOS study.
abstract: OBJECTIVE
  Fixed-dose combinations of inhaled corticosteroids and long-acting β2-agonists have proven to prevent and reduce chronic obstructive pulmonary disease (COPD) exacerbations. The aim of this analysis was to explore the clinical consequences and direct health care costs of applying the findings of the PATHOS (An Investigation of the Past 10 Years Health Care for Primary Care Patients with Chronic Obstructive Pulmonary Disease) study to the Italian context.
  
  
  METHODS
  Effectiveness data from the PATHOS study, a population-based, retrospective, observational registry study conducted in Sweden, in terms of reduction in COPD and pneumonia-related hospitalizations, were considered, in order to estimate the differences in resource consumption between patients treated with budesonide/formoterol and fluticasone/salmeterol. The base case considers the average dosages of the two drugs reported in the PATHOS study and the actual public price in charges to the Italian National Health Service, while the difference in hospitalization rates reported in the PATHOS study was costed based on Italian real-world data.
  
  
  RESULTS
  The PATHOS study demonstrated a significant reduction in COPD hospitalizations and pneumonia-related hospitalizations in patients treated with budesonide/formoterol versus fluticasone/salmeterol (-29.1% and -42%, respectively). In the base case, the treatment of a patient for 1 year with budesonide/formoterol led to a saving of €499.90 (€195.10 for drugs, €193.10 for COPD hospitalizations, and €111.70 for pneumonia hospitalizations) corresponding to a -27.6% difference compared with fluticasone/salmeterol treatment.
  
  
  CONCLUSIONS
  Treatment of COPD with budesonide/formoterol compared with fluticasone/salmeterol could lead to a reduction in direct health care costs, with relevant improvement in clinical outcomes.
authors.affiliation: ProCure Solutions, Bergamo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
authors.affiliation: Respiratory Unit, Mater Salutis Hospital, Legnago, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Micheletto
authors.affiliation: ProCure Solutions, Bergamo, Italy.
authors.forename: Daniela Paola
authors.initials: DP
authors.lastname: Roggeri
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007558:Italy; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011014:Pneumonia / Q000191:economics / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D012042:Registries; D019141:Respiratory System Agents / Q000008:administration & dosage* / Q000191:economics*; D012189:Retrospective Studies; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations; D019141:Respiratory System Agents
keywords: direct health care costs; disease management; hospitalizations; pharmacoeconomics