Direct healthcare costs associated with management of asthma: comparison of two treatment regimens in Indonesia, Thailand and Vietnam

Figures & data

Table 1. Study design of the three clinical studies.

	AHEAD ^a	COMPASS ^b	COSMOS ^c
Study design	6-month, randomized, double-blind, parallel group	6-month, randomized, double-blind, double dummy, parallel group	12-month, randomized, open-label, parallel group
Countries/sites	17/184	16/235	16/246
Treatment comparison	FP/salm 500/50 µg x1 inhalation bid + terb as needed Bud/form 160/4.5 µg x2 inhalation bid + Bud/form as needed	FP/salm 125/25 µg x 2 inhalation bid + terb as needed Bud/form 320/9 µg x1 inhalation bid + terb as needed^d Bud/form 160/4.5 µg x1 inhalation bid + Bud/form as needed	FP/salm 250/50 µg x1 inhalation bid (dose could be changed to 100/50 µg x1 inhalation bid or 500/50 µg x1 inhalation bid) + salb as needed Bud/form 160/4.5 µg x2 inhalations bid (dose could be changed to 160/4.5 µg x1 inhalations bid) + Bud/form as needed
Number of randomized patients	2,309	3,335	2,143
Patient population
Mean age (years)	39	38	45
Mean baseline FEV1 % predicted (%)	71	73	73
Primary endpoint	Time to first severe exacerbation	Time to first severe exacerbation	Time to first severe exacerbation

Note. Bid: twice daily; Bud/form: budesonide/formoterol; FP/salm: fluticasone propionate/salmeterol; MART: maintenance and reliever therapy, salb: salbutamol; terb: terbutaline.

a Reference (25).

b Reference (26).

c Reference (27).

d Data from this study arm not included in economic analysis.

Table 2. Country specific unit costs (2019, conversion to British pound sterling (GBP)).

Resource utilization measure	Indonesia		Thailand		Vietnam
	Cost (rupiah)	Cost (GBP)	Cost (baht)	Cost (GBP)	Cost (dong)	Cost (GBP)
Hospitalization, per day
ICU	17,363,900 ^a	961.56	5,070 ^b	127.93	2,100,000 ^c	71.38
General ward	8,628,000 ^a	477.79	1,953 ^b	49.28	1,156,230 ^c	39.30
Healthcare visit, per visit
Emergency room	1,198,100 ^a	66.35	796.36 ^d	20.09	1,267,750 ^e	43.09
Specialist	200,000 ^f	11.08	306 ^g	7.72	313,777 ^h	10.66
General care physician	80,000 ^f	4.43	101 ^g	2.55	355,321 ^h	12.08
Other	80,000 ^f	4.43	118 ^g	2.98	1,451,475 ^h	49.33
Home visit, per visit
General care physician	80,000 ^f	4.43	359.3 ^g	9.07	1,451,475 ^h	49.33
Other	80,000 ^f	4.43	359.3 ^g	9.07	1,451,475 ^h	49.33
Medication, per patient per dose/puff
Bud/Form + Bud/Form (160/4.5 µg)	2,238 ^i	0.12	7.42 ^j	0.19	5,001 ^k	0.17
Bud/form (320/9 µg)	n/a	n/a	10.52 ^j	0.27	n/a	n/a
FP/salm (125/25 µg)	1,155 ^l	0.07	2.50 ^j	0.06	1,972.98 ^k	0.07
FP/salm (100/50 µg)	1,817 ^i	0.10	6.42 ^j	0.16	3,945.96 ^l	0.07
FP/salm (250/50 µg)	2,042 ^i	0.11	7.79 ^j	0.20	4,524.80 ^k	0.15
FP/salm (500/50 µg)	2,233 ^i	0.12	9.95 ^j	0.25	5,865.40 ^k	0.20
Salbutamol	157 ^i	0.01	0.23 ^j	0.01	470.38 ^k	0.02
Terbutaline (0.4 mg)	622 ^i	0.03	0.23 ^j	0.01	470.38 ^k	0.02

Notes. Cost of FP/salm 100/50 (i.e. dry powder device) was not available, and per unit cost was assumed twice that of the FP/salm 125/25 (i.e. metered dose inhaler), since these are clinically equivalent. Bud/form: budesonide/formoterol; FP/salm: fluticasone propionate/salmeterol; ICU: intensive care unit.

Exchange rates used: 1 GBP = 18 058 rupiah; 1 GBP = 29 422 dong; 1 GBP = 39.63 baht (28).

a Reference (29).

b Reference (24).

c Reference (36).

d Reference (33).

e Reference (37).

f Reference (30).

g Reference (34).

h Reference (38).

i Reference (31).

j Reference (35).

k Reference (39).

l Reference (32).

Table 3. Average resource use per patient per year by treatment option in each study.

	AHEAD ^a,^b		COMPASS ^b,^c		COSMOS ^b,^d
	FP/Salm	MART	FP/Salm	MART	FP/Salm	MART
Hospitalization
ICU	0	0.01	0.012	0.048	0.005	0.009
General ward	0.05	0.06	0.296	0.074	0.09	0.05
Healthcare visit
ED	0.104	0.094	0.178	0.134	0.06	0.04
Specialist	0.240	0.152	0.408	0.314	0.24	0.17
GP	0.192	0.168	0.270	0.282	0.37	0.32
Other	0.056	0.028	0.096	0.074	0.10	0.05
Home visit
GP	0.016	0.010	0.016	0.006	0.04	0.03
Other	0.006	0.002	0.044	0.006	0.01	0
Medication (per patient per day)
Bud/Form + Bud/Form (160/4.5 µg)	–	4.879	–	3.250	–	3.940
Bud/form (320/9 µg)	–	–	–	–	–	–
FP/salm (125/25 µg)	–	–	4.304	–	–	–
FP/salm (100/50 µg)	–	–	–	–	0.233	–
FP/salm (250/50 µg)	–	–	–	–	1.214	–
FP/salm (500/50 µg)	1.978	–	–	–	0.490	–
Salbutamol	–	–		–	0.907	–
Terbutaline (0.4 mg)	0.995	–	1.036	–	–	–

Notes. Data for AHEAD and COMPASS studies extrapolated to 1 year. Bud/form: budesonide/formoterol; ED: emergency department; FP/salm: fluticasone propionate/salmeterol; GP: general practitioner; ICU: intensive care unit.

^aReference (25).

^bResource use data from reference (24).

^cReference (26).

^dReference (27).

Figure 1. Average total direct costs by treatment option in each study in (a) Indonesia, (b) Thailand and (c) Vietnam.

Figure 2. Average total direct costs by treatment option across all studies in Indonesia, Thailand and Vietnam.

Table 4. Average total direct costs by treatment option in each study by country.

Study	Country-treatment arm	Medication costs (GBP)	Healthcare costs (GBP)	Total direct costs (GBP)
AHEAD ^a	ID – FP/salm	102	35	137
	ID – MART	220	47	267
	TH – FP/salm	183	7	190
	TH – MART	332	8	340
	VT – FP/salm	149	15	164
	VT – MART	302	13	315
COMPASS ^b	ID – FP/salm	113	171	284
	ID – MART	147	96	243
	TH – FP/salm	101	24	125
	TH – MART	221	16	237
	VT – FP/salm	111	35	146
	VT – MART	201	23	224
COSMOS ^c	ID – FP/salm	83	57	140
	ID – MART	178	39	217
	TH – FP/salm	147	10	157
	TH – MART	268	7	275
	VT – FP/salm	120	21	141
	VT – MART	244	14	258

Notes. Data rounded to nearest GBP. Bud/form: budesonide/formoterol; FP/salm: fluticasone propionate/salmeterol.

^aReference (25).

^bReference (26).

^cReference (27).

Bousquet J, Boulet LP, Peters MJ, Magnussen H, Quiralte J, Martinez-Aguilar NE, Carlsheimer A. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone. Respir Med. 2007;101(12):2437–2446. doi:https://doi.org/10.1016/j.rmed.2007.07.014.

 PubMed Web of Science ®Google Scholar

Kuna P, Peters MJ, Manjra AI, Jorup C, Naya IP, Martínez-Jimenez NE, Buhl R. Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract. 2007;61(5):725–736. doi:https://doi.org/10.1111/j.1742-1241.2007.01338.x.

 PubMed Web of Science ®Google Scholar

Vogelmeier C, D’Urzo A, Pauwels R, Merino JM, Jaspal M, Boutet S, Naya I, Price D. Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?Eur Respir J. 2005;26(5):819–828. doi:https://doi.org/10.1183/09031936.05.00028305.

 PubMed Web of Science ®Google Scholar

UNCTADstat annual currency exchange rates; 2019. Available from: https://unctadstat.unctad.org/wds/TableViewer/tableView.aspx?ReportId=117[last accessed 6 July 2020].

 Google Scholar

Peraturan Menterl Kesehatan Republik Indonesia Nomor 64 Tahun; 2016. Available from: http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._64_ttg_Standar_Tarif_Pelayanan_Kesehatan_Dalam_Penyelenggaraan_Program_Jaminan_Kesehatan_.pdf [last accessed 15 July 2020].

 Google Scholar

Boonsawat W. Cost-effectiveness of budesonide/formoterol maintenance and rescue therapy in Thailand. Asian Biomed. 2010;4(4):571–578. doi:https://doi.org/10.2478/abm-2010-0072.

 Google Scholar

Hospital price list (current version in 2019). Ho Chi Minh City, Vietnam: University Medical Center.

 Google Scholar

Puranitee P, Kamchaisatian W, Manuyakorn W, Vilaiyuk S, Laecha O, Pattanaprateep O, Benjaponpitak S. Direct medical cost of Thai pediatric asthma management: a pilot study. Asian Pac J Allergy Immunol. 2015;33:296–300. doi:https://doi.org/10.12932/AP0494.33.4.2015.

 PubMed Web of Science ®Google Scholar

Lai CKW, Kim Y-Y, Kuo S-H, Spencer M, Williams AE. Cost of asthma in the Asia-Pacific region. Eur Respir Rev. 2006;15(98):10–16. doi:https://doi.org/10.1183/09059180.06.00009802.

 Google Scholar

Tarif RSUP Persahabatan 2017. Available from: https://rsuppersahabatan.co.id/tarif [last accessed 15 July 2020].

 Google Scholar

Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand; 2010. Available from: http://costingmenu.hitap.net/ [last accessed 15 July 2020].

 Google Scholar

Brakema E, Nguyen Thanh L, Kasteleyn M, van der Kleij R, Hasenack B, Nguyn Nhat Q, Nguyen Lam V, Nguyen Nhu V, Diep Tuan T, Postma M, et al. Fresh air: health economic burden of asthma & COPD in Vietnam; 2020. Available from:https://old.theipcrg.org/download/attachments/38535324/Evelyn%20Brakema%20-%20FRESH%20AIR%20Health%20Economic%20Burden%20of%20Asthma%20and%20COPD%20in%20Vietnam.pdf?version=1&modificationDate=1510911834000&api=v2 [last accessed 15 July 2020].

 Google Scholar

eCatalog obat 2018 v5.0. Available from: https://e-katalog.lkpp.go.id/ [last accessed 15 July 2020].

 Google Scholar

National drug information, Thailand, version dated 9 December 2019. Available from: http://ndi.fda.moph.go.th/drug_value/index/public/ [last accessed 15 July 2020].

 Google Scholar

Daily Item Price List Report; 17 June 2020. Published by Zuellig Pharma Internal system.

 Google Scholar

MIMS Indonesia; 2020. Available from: https://www.mims.com/indonesia/drug/info/seretide [last accessed 6 August 2020].

 Google Scholar

Availability of data and materials

Information on GSK’s data sharing commitments and requesting access can be found at: https://www.clinicalstudydatarequest.com.