Fluticasone furoate plus vilanterol in patients with moderate persistent asthma: a cost-utility analysis

Abstract

Background

In recent years, the combination of fluticasone furoate and vilanterol (FF/VI) has emerged as an alternative therapy, since it is administered every 24 h, in contrast to other ICS/LABAs such as fluticasone propionate plus salmeterol (FP/Salm), which requires administration every 12 h. Concerns have arisen over whether the benefit generated by FF/VI justifies the additional costs it involves over FP/Salm. This study aimed at assessing the health and economic consequences of FF/VI in patients with moderate-severe persistent asthma.

Methods

A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs for FF/VI and FP/Salm were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.

Results

We estimated a gain of 16.8 and 10.7 QALYs per patient per year on FF/VI and FP/Salm, respectively. At the same time, we observed a difference of US$216 in total discounted cost per person-year on FF/VI with respect to FP/Salm. The incremental cost-effectiveness ratio (ICER) of FF/VI was USD $70 per QALY with respect to FP/Salm. In the deterministic and probabilistic sensitivity analyses, our base-case results were robust to variations in all assumptions and parameters.

Conclusion

FF/VI is more cost-effective than FP/Salm. The evidence supports using FF/VI therapy in Colombia, and the study should be replicated in other middle-income countries.

Keywords:

• Fluticasone furoate
• uncontrolled asthma
• cost-effectiveness analysis
• Colombia
• Markov model

Author’s contributions

All authors contributed equally to the manuscript conceptualization, methodology, analysis, data curation, and writing review. All authors have read and agreed to the published version of the manuscript

Declaration of interest

All authors declare that they do not have any conflict of interest with respect to this publication.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of the University of Antioquia (2015–4690).

Data availability statement

The raw data supporting our findings can be found at http://ciemto.medicinaudea.co/.

Additional information

Funding

Self-funding by the authors.