A budget impact analysis of budesonide/formoterol in patients with mild asthma in Egypt

Figures & data

Figure 1. Budget impact model structure.

Table 1. Model input parameters.

	Base case	Low value	High value
Annual probabilities
Severe exacerbations leading to hospitalization_symbicort.	0.005	0.0045	0.0055
Severe exacerbations leading to hospitalization_salbutamol.	0.01	0.0108	0.0132
Severe exacerbations leading to ERV & SGU_symbicort.	0.005	0.0045	0.0055
Severe exacerbations leading to ERV & SGU_salbutamol.	0.023	0.0207	0.0253
Severe exacerbations leading to SGU for ≥3 days_symbicort.	0.055	0.0495	0.0605
Severe exacerbations leading to SGU for ≥3 days_salbutamol.	0.11	0.099	0.121
All moderate or severe exacerbations_symbicort.	0.103	0.0927	0.1133
All moderate or severe exacerbations_salbutamol	0.215	0.1935	0.2365
Annualized rate for severe exacerbations_symbicort.	0.07	0.063	0.077
Annualized rate for severe exacerbations_salbutamol.	0.2	0.18	0.22
Annualized rate for moderate and severe exacerbations_symbicort.	0.14	0.126	0.154
Annualized rate for moderate and severe exacerbations_salbutamol	0.36	0.324	0.396
Unit costs in severe exacerbations (EGP)
Central Venous Pressure (CVP) line	150	120	180
Mechanical ventilation/day	60	48	72
Units of symbicort estimated to be utilized by 1 pt per year (120 doses)	2	1	3
Units of salbutamol estimated to be utilized by 1 pt per year (240 doses)	2	1	3
MgSO4 2 ampoule/day	2	1.6	2.4
Nebulizer/hour	85	68	102
Pulmicort 0.5 mg	10.19	8.15	12.23
Farcoline 2.5 mg	3.52	2.82	4.23
Atrovent 500 µg	2.00	1.60	2.40
Solucortef (1–2 mg/kg; 250 mg)/6 h	38.4	30.72	46.08
Antibiotic (Tavanic injection, 750 mg/day)	22.35	17.88	26.82
Etaphylline 1 µg/kg/12 h	2.7	2.16	3.24
Theophylline IV blood level (twice in stay)	68	54.4	81.6
IV Fluids (0.9% Saline)	13.82	11.06	16.59
IV Fluids (Ringer acetate)	15.75	12.6	18.9
Antibiotic (Tavanic tablets, 1/day) for 5 days	6	4.8	7.2
Oral solupred 40 mg/day (9 days)	43.64	34.91	52.37
Etaphylline/8 h for 5 days	5.1	4.08	6.12
Fluids/day + renal function tests + Complete Blood Count (CBC)	313.60	250.88	376.32
Pulmicort + farcoline + atrovent	64.36	51.48	77.23
Unit costs for monitoring tests/follow-up (EGP)
Renal function	45	36	54
Liver function	45	36	54
Blood Sugar Test (1st Day)	30	24	36
Arterial blood gases (in severe attack) every other day	800	640	960
Spirometry (peak flow meter)/pulmonary function (ward)	300	240	360
ECHO	200	160	240
Immunoglobulin E test	54	43.2	64.8
X-ray	200	160	240
CBC	32	25.6	38.4
Electrocardiogram (ECG)	25	20	30
Ward cost per day	425	340	510
ERV cost (IV Fluids + corticosteroids + nebulizer)	641.49	513.19	769.79
ICU cost per day	825	660	990
Physician visit cost	150	120	180
Physician visits # (per month)_salbutamol	12	9.6	14.4
Physician visits # (per 3 months)_symbicort	4	3.2	4.8
Unit costs in moderate exacerbations (EGP)
Acetyl cysteine sachets /12 h in 10 days	0.84	0.66	1.00
Oral theophylline 1/2 tablet/12 h	0.34	0.27	0.40
Management cost of side-effects/year (EGP)
Upper respiratory tract infection	30	24	36
Viral upper respiratory tract infection	2.38	1.904	2.856
Fungal Pharyngitis	6.6	5.28	7.92
Bronchitis	30	24	36
Side effects rate_symbicort
Upper respiratory tract infection	5.60%	0.0448	0.0672
Viral upper respiratory tract infection	5.90%	0.0472	0.0708
Pharyngitis	2.60%	0.0208	0.0312
Bronchitis	2.60%	0.0208	0.0312
Side effects rate_salbutamol
Upper respiratory tract infection	6.00%	0.048	0.072
Viral upper respiratory tract infection	6.20%	0.0496	0.0744
Pharyngitis	2.70%	0.0216	0.0324
Bronchitis	3.20%	0.0256	0.0384
Other parameters
Total population > 14 years	61,370,000	49,096,000	73,644,000
# of patients with Asthma	4,111,790	3,289,432	4,934,148
# of patients diagnosed and treated for Mild Asthma	1,222,024	977,619	1,466,429
Targeted population	611,012	488,810	733,214
% of targeted patients covered by Health Insurance Organization	359,275	287,420	431,130
Number of Poorly Controlled Asthma Weeks Per Patient_symbicort	7.7	6.16	9.24
Number of Poorly Controlled Asthma Weeks Per Patient_salbutamol	9.7	7.76	11.64
# of productive days lost in a poorly controlled asthma week	3	2.40	3.60
Average daily wage in Egypt	133.83	107.06	160.60

Abbreviations. ERV, emergency visits; SGU, systematic glucocorticoids.

Table 2. Market penetration for treatment options.

Market penetration	Year 1	Year 2	Year 3
New scenario: budesonide/formoterol	30%	60%	75%
New scenario: salbutamol	70%	40%	25%
Current scenario: salbutamol	100%	100%	100%

Figure 2. The total annual costs (drug and non-drug) of current and new scenarios in mild asthma from an HIO perspective. (a) The total drug costs for the two scenarios. (b) The total non-drug costs for the two scenarios. (c) The total drug costs per patient for the two scenarios. (d) The total non-drug costs per patient for the two scenarios.

Table 3. The total direct annual costs (drug and non-drug) of current and new scenario in mild asthma.

	Current scenario	New scenario
Year 1	EGP 2.854 billion	EGP 2.302 billion
Year 2	EGP 2.854 billion	EGP 1.749 billion
Year 3	EGP 2.854 billion	EGP 1.473 billion
Total direct costs	EGP 8.563 billion	EGP 5.525 billion
Total budget savings	EGP 3.038 billion

Figure 3. The total number of exacerbations of current and new scenarios in mild asthma from an HIO perspective.

Figure 4. One-way sensitivity results from an HIO perspective. Black bars indicate the higher values while the grey bars indicate the lower values.

Figure 5. One-way sensitivity results from a societal perspective. Black bars indicate the higher values while the grey bars indicate the lower values.