Cost-utility of as-needed ICS-formoterol versus to maintenance ICS in mild to moderate persistent asthma

BMC Pulmonary Medicine

Diana Guerrero Patiño¹  Jefferson Antonio Buendía² 

[1] Hospital Infantil Concejo de Medellin, Medellin, Colombia;Research Group in Pharmacology and Toxicology ”INFARTO”. Department of Pharmacology and Toxicology, Facultad de Medicina, University of Antioquia, Carrera 51D #62-29, Medellin, Colombia;

关键词: Budesonide-formoterol;    Uncontrolled asthma;    Cost-effectiveness analysis;    Decision analysis;    Markov model;   

DOI  :  10.1186/s12890-021-01775-1

来源: Springer

【 摘 要 】

BackgroundRecent asthma guidelines, such as the Global Initiative for Asthma (GINA), recommend in adult patients as-needed inhaled corticosteroids (ICS)-formoterol as an alternative to maintenance ICS in mild to moderate persistent asthma. The introduction of these recommendations concerns whether using as-needed budesonide-formoterol would be more cost-effective than to maintenance ICS. This study aimed to evaluate the cost-effectiveness of as-needed combination low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) reliever therapy in patients with mild asthma.MethodsA probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with mild asthma in Colombia. Total costs and QALYs of low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.ResultsThe model suggests a potential gain of 0.37 QALYs and per patient per year on as-needed ICS-formoterol and a reduction in the discounted cost per person-year, of as-needed ICS-formoterol to maintenance ICS, of US$40. This position of dominance of as-needed ICS-formoterol negates the need to calculate an incremental cost-effectiveness ratio. In the deterministic and probabilistic sensitivity analysis, our base‐case results were robust to variations in all assumptions and parameters.ConclusionLow-dose budesonide-formoterol as a reliever was cost-effective when added to usual care in patients with mild asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

【 授权许可】

CC BY