A systematic review of economic evaluations of therapy in asthma

Abstract

Background:

Asthma’s cost-effectiveness is a major consideration in the evaluation of its treatment options. Our objective was to perform a systematic review of the cost-effectiveness of asthma medications.

Methods:

We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, OHE-HEED, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessments Database, NHS Economic Evaluation Database, and Web of Science and reviewed references from key articles between 1990 and Jan 2008.

Results:

A total of 49 RCTs met the inclusion criteria. Maintenance therapy with inhaled corticosteroids was found to be very cost-effective and in uncontrolled asthmatics patients currently being treated with ICS, the combination of an ICS/LABA represents a safe, cost-effective treatment. The simplified strategy using budesonide and formoterol for maintenance and reliever therapy was also found to be as cost-effective as salmeterol/fluticasone plus salbutamol. Omalizumab was found to be cost-effective. An important caveat with regard to the published literature is the relatively high proportion of economic evaluations which are funded by the manufacturers of specific drug treatments.

Conclusion:

Future studies should be completed independent of industry support and ensure that the comparator arms within studies should include dosages of drugs that are equivalent.

Keywords:

• asthma
• medication
• cost-effectiveness
• cost of illness
• economic costs

Acknowledgments/disclosure

JMF is a Michael Smith Foundation for Health Research Distinguished Scholar. This work was supported by the National Sanatorium Association. KB has no conflicts of interest. JMF has received consulting fees and also has spoken at industry organized symposia from companies who market asthma drugs. These companies have included Astra Zeneca, GlaxoSmithKline, Merck Frost, and Nycomed. He is also a member of the Canadian Thoracic Society Asthma Guidelines working group and a member of the Global Initiative in Asthma (GINA) executive and Chair of its Science Committee.