Budget Impact Analysis of a Fixed-Dose Combination of Fluticasone Propionate and Formoterol Fumarate (FP/FORM) in a Pressurized Metered-Dose Inhaler (pMDI) for Asthma
- 316 Downloads
The economic burden of asthma on the UK National Health Service (NHS) is the largest among allergic diseases. Current asthma guidelines recommend adding a long acting β2-agonist (LABA) to a low-dose inhaled corticosteroid (ICS) in patients who are on ICS monotherapy and have uncontrolled asthma. The fixed-dose combination of fluticasone propionate and salmeterol xinafoate (FP/SAL), available in a pressurized metered-dose inhaler (pMDI) device, is the most commonly prescribed ICS/LABA combination. An additional fixed-dose combination of fluticasone propionate and formoterol fumarate (FP/FORM) in pMDI is now available. In a 12-week non-inferiority study, FP/FORM demonstrated comparable efficacy to FP/SAL. The present analysis estimates the annual budget impact for the UK NHS using FP/FORM as an alternative to FP/SAL.
Current pMDI prescribing data were from a real-world UK patient database (Cegedim Strategic Data). Annual costs to the NHS for drug acquisition, administration, and monitoring were estimated for FP/FORM and FP/SAL and used to assess the potential budget impact for the NHS for the use of FP/FORM instead of FP/SAL. Varying rates of uptake, adherence, adverse event-related costs, and resource use associated with switching treatment were assessed in scenario analyses.
Assuming similar levels of ICS use with both regimens, annual drug acquisition costs per person were lower with FP/FORM (£412) than with FP/SAL (£509). The difference in acquisition costs and otherwise comparable input costs between the treatments, results in potential annual savings of £15,110,279 to the NHS, assuming uptake of FP/FORM over FP/SAL in 50% of existing patients. The introduction of FP/FORM results in cost savings for the NHS in all of the assessed scenario analyses.
The comparable efficacy and lower acquisition costs of FP/FORM compared with FP/SAL make it a cost-saving option for the UK NHS for the treatment of asthma patients requiring combination maintenance therapy using a pMDI.
KeywordsAsthma Budget Cost savings Fluticasone propionate Formoterol fumarate Pressurized metered-dose inhaler Respiratory
Sponsorship and article processing charges for this study were funded by Mundipharma International Ltd, United Kingdom. Adelphi Values Ltd received funding from Mundipharma International Ltd to support this research. Mr. Dunlop is the guarantor for this article, and takes responsibility for the integrity of the work as a whole.
Conflict of interest
William Dunlop is an employee of Mundipharma International Ltd, United Kingdom. Louise Heron is an employee of Adelphi Values Ltd, UK. Georgia Fox is an employee of Adelphi Values Ltd, UK. Maire Greaney is an employee of Adelphi Values Ltd, UK. The authors do not report any conflict of interest with regards to the contents of this study other than those stated.
Compliance with ethics
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.Asthma UK. Key facts and statistics. 2012. http://www.asthma.org.uk/news-centre/facts-for-journalists. Accessed 24 Jan 2013.
- 4.NHS Improvement—Lung: National Improvement Projects. Improving adult asthma care: emerging learning from the national improvement projects. 2012 Leicester, UK. http://www.improvement.nhs.uk/documents/asthmaimprovement.pdf. Accessed 24 Jan 2013.
- 5.Asthma UK. Wish you were here? UK report. 2008. http://asthmaserver.umbrellainc.co.uk/media/141035/wish_you_were_here__-_england_report.pdf. Accessed 24 Jan 2013.
- 7.British Thoracic Society/Scottish Intercollegiate Guidelines Network. British Guideline on the management of asthma. http://www.sign.ac.uk/pdf/qrg101.pdf. Accessed 24 Jan 2013.
- 8.Global strategy for asthma management and prevention. 2012. http://www.ginasthma.org/local/uploads/files/GINA_Report_March13.pdf. Accessed 24 Jan 2013.
- 17.CSD Patient Data. Cegedim Strategic Data UK Ltd. 2012.Google Scholar
- 18.Napp Pharmaceuticals Limited. Flutiform summary of product characteristics. http://www.medicines.org.uk/emc/medicine/26954/SPC/flutiform+50+microgram+5+microgram%2c+125+microgram+5+microgram+and+250+microgram+10+microgram+per+actuation+pressurised+inhalation%2c+suspension. Accessed 24 Jan 2013.
- 19.British National Formularity (BNF). 2013. http://www.bnf.org/bnf/index.htm. Accessed 28 May 2013.
- 22.Seretide 50, 125, 250 Evohaler summary of product characteristics. http://www.medicines.org.uk/EMC/medicine/2914. Accessed 31 Aug 2013.
- 23.Global initiative for asthma (GINA). Pocket guide for asthma management and prevention. 2012. http://www.ginasthma.org/local/uploads/files/GINA_Pocket2013_May15.pdf. Accessed 24 June 2013.
- 24.European Medicines Agency. Augmentin summary of product characteristics. 2009. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Augmentin_30/WC500090608.pdf. Accessed 31 Aug 2013.
- 25.Personal Social Services Research Unit (PSSRU). Unit costs of health and social care 2012. http://www.pssru.ac.uk. Accessed 24 June 2013.
- 26.NHS England. Proposed CCG configuration and member practices published. http://www.england.nhs.uk/2012/05/24/ccg-configuration. Accessed 31 May 2013.
- 29.Aalbers R, Brusselle G, McIver T, Grothe B, Bodzenta-Lukaszyk A. Onset of bronchodilation with fluticasone/formoterol combination versus fluticasone/salmeterol in an open-label, randomized study. Adv Ther. 2012;29:958-69.Google Scholar
- 32.Scottish Medicines Consortium. Fluticasone/formoterol (Flutiform). 2012. http://www.scottishmedicines.org.uk/SMC_Advice/Advice/736_11_fluticasone_formoterol_mdi_inhaler_Flutiform/fluticasone_formoterol_Flutiform. Accessed 24 June 2013.
- 33.National Institute for Health and Clinical Excellence (NICE). Technology appraisal guidance 138. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. http://www.nice.org.uk/TA138. Accessed 24 Jan 2013.