title: Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study.
abstract: BACKGROUND
  Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).
  
  
  METHODS
  These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.
  
  
  RESULTS
  In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95% confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95% CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98% probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100% probabilities in the US.
  
  
  CONCLUSIONS
  Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.
authors.affiliation: National Jewish Health, Denver, CO, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
authors.affiliation: 1] Academic Primary Care, University of Aberdeen, Aberdeen, UK [2] Research in Real Life, Ltd, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Cochin Hospital Group, AP-HP, University of Paris Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.affiliation: Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: Willem M C
authors.initials: WM
authors.lastname: van Aalderen
authors.affiliation: Blizard Institute, Queen Mary University of London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grigg
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.affiliation: Research in Real Life, Ltd, Cambridge, UK.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Hillyer
authors.affiliation: Research in Real Life, Ltd, Cambridge, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Burden
authors.affiliation: Research in Real Life, Ltd, Cambridge, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: von Ziegenweidt
authors.affiliation: Washington Hospital Center and George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Colice
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy* / Q000191:economics*; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D012189:Retrospective Studies; D006113:United Kingdom; D014481:United States; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones