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ABSTRACT
Background: Budesonide/formoterol maintenance and reliever therapy has shown its effectiveness as a treatment for moderate-to-severe asthma.
Objective: To explore the cost-effectiveness of budesonide/formoterol maintenance and reliever therapy as compared to fixed combination therapies (budesonide/formoterol and salmeterol/fluticasone) with terbutaline as needed in the treatment of asthma in Finland.
Methods: Patients without asthma exacerbations during a 6-month period were used as the effectiveness variable in the within-trial economic analysis. Finnish unit costs were applied to pooled resource use data, and multinomial cost-effectiveness plane and acceptability curves were formed based on bootstrapping.
Results: Use of budesonide/formoterol maintenance and reliever therapy significantly reduced the rate of severe asthma exacerbations as compared with a fixed dose of budesonide/formoterol or salmeterol/fluticasone and terbutaline as needed. Total costs over 6 months were €496 per patient for those who used the budesonide/formoterol maintenance and reliever therapy treatment model, which was €78–101 lower than the cost of fixed combinations of salmeterol/fluticasone or budesonide/formoterol with terbutaline as needed. The results indicate that the budesonide/formoterol maintenance and reliever therapy achieves a high probability (> 93%) of cost effectiveness irrespective of willingness to pay level.
Conclusions: Budesonide/formoterol maintenance and reliever therapy may be considered in the treatment of moderate-to-severe asthma instead of conventional treatment with combination products in view of its good clinical efficacy and a high probability of cost-effectiveness in the Finnish setting. However, a cost-effectiveness analysis with a longer time horizon, more Finnish-specific data, and ICS + short/long-acting inhaled β2-agonist as an additional comparator is still warranted.
Acknowledgements
Declaration of interest: This study was supported by AstraZeneca Finland. K. T. and J. L. are employees of AstraZeneca Finland. E. S. and J. M. are employed by ESiOR Oy (a consultancy that received support from AstraZeneca) and they both hold stocks in ESiOR Ltd. H. K. received a consulting fee from AstraZeneca Finland. H.K. has also been reimbursed and/or received honoraria for attending and speaking at scientific meetings; participating as an advisory-board member, consultant, author and/or investigator; and attending courses financed by various pharmaceutical companies (AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, LabPharma Ltd., Merck, Sharp & Dohme, Pfizer). The institution where H.K. was employed received research funding from Orion Pharma and UCB Pharma.
The authors would like to acknowledge the contributions of all the investigators who participated in the clinical study and the health-economic analyses. They would also like to acknowledge Lance Brannman and Carl Mellström (AstraZeneca R&D Lund, Sweden) for their contributions to the article.
Notes
* These results will be presented as a poster at the 11th International Society for Pharmacoeconomics and Outcomes Research (ISPOR) European Congress, 8–11 November 2008, Athens, Greece
* Symbicort SMART is a registered trademark of AstraZeneca