https://orcid.org/0000-0002-2524-6854
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Abstract
Purpose
Reducing the risk of exacerbation is a long-term goal of managing moderate-to-severe asthma. The use of fluticasone propionate/formoterol fumarate dihydrate (FP/FORM) pressurized metered-dose (pMDI, Flutiform®), a type of inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) fixed-dose combination, has been associated with lower oral corticosteroid-requiring exacerbation rates than other ICS/LABA fixed-dose combinations, fluticasone propionate/salmeterol xinafoate (FP/SAL) and budesonide/formoterol fumarate (BUD/FORM). This study presents the first budget impact analysis of drug and exacerbation management cost savings associated with the increased access to FP/FORM compared to the currently available ICS/LABAs for treating moderate-to-severe asthma in Singapore.
Patients and Methods
A budget impact model showed changes to annual drug and exacerbation costs over 5 years for patients with moderate-to-severe asthma in Singapore, following the inclusion of FP/FORM on a government subsidy list. The eligible patient population was identified based on national statistics data. Different treatment costs pertaining to the population were applied according to the usage data (IQVIA Singapore National Sales Data) for different scenarios. Drug costs were obtained from public-sector hospitals. Exacerbation management costs were obtained from literature searches.
Results
The analysis showed that increased access to FP/FORM as a result of switching from FP/SAL could help achieve drug (S$1,042,289) and exacerbation management (S$223,550) cost savings over 5 years. In the scenario where patients switched from BUD/FORM, greater drug (S$2,572,797) and exacerbation management (S$256,781) cost savings were observed over 5 years.
Conclusion
The analysis provides a perspective that the increased access to FP/FORM could help achieve drug and exacerbation cost savings for the treatment of moderate-to-severe asthma.
Abbreviations
BUD, budesonide; DPI, dry powder inhaler; FORM, formoterol fumarate; FP, fluticasone; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; HSA, Science Authority; LABA, long-acting β2 agonist; OCS, oral corticosteroid-requiring; pMDI, pressurized metered-dose inhaler; SAL, salmeterol xinafoate.
Data Sharing Statement
IQVIA Singapore National Sales 2016–2018 data were data on file and are not available for sharing.
Acknowledgments
The authors acknowledge support for third-party writing assistance for this article, provided by Min Hee Choi, PhD, Costello Medical Singapore Pte Ltd, Singapore, funded by Mundipharma Singapore Holding Pte Limited, Singapore in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). The authors also acknowledge Dr Lim Hui Fang, National University of Singapore, Singapore, for providing and validating inputs required for the research. The authors thank Rohini Bose, PhD, from Costello Medical Singapore Pte Ltd, Singapore, for her guidance and support in the research.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Sebastien Boisseau, Murtaza Qasuri, Weng Tong Ho and Yacine Hadjiat are employees of Mundipharma Singapore Holding Pte Limited, Singapore. Wrik Ghosh was an employee of Costello Medical Singapore Pte Ltd, Singapore during the development of the model and manuscript. The authors report no other conflicts of interest in this work.