PharmacoEconomics Spanish Research Articles

, Volume 7, Issue 4, pp 163–175 | Cite as

Análisis coste-efectividad de budesonida/formoterol en el tratamiento de mantenimiento y a demanda (Symbicort SMART®) frente a salmeterol/fluticasona más terbutalina, en el tratamiento del asma persistente en España

  • Carolina Cisneros
  • Joaquín Quiralte
  • Margarita Capel
  • Miguel Ángel Casado
  • Carl Mellstrom
Artículo de Investigación Original

Resumen

Objetivo: Estimar el coste-efectividad de dos inhalaciones de budesonida/formoterol 160/4,5 μg dos veces al día más budesonida/formoterol a demanda (Symbicort SMART®) frente a una inhalación de salmeterol/fluticasona 50/500 μg dos veces al día más terbutalina a demanda (SFT) en pacientes con asma persistente, desde la perspectiva del Sistema Nacional de Salud (pSNS) y la perspectiva social (pS) en España.

Pacientes y método: Los costes unitarios españoles (€ 2009) se aplicaron al uso de recursos de un ensayo clínico aleatorizado de seis meses de duración con 2.309 pacientes (AHEAD; Bousquet. Resp Med 2007). La variable de eficacia fue el número de exacerbaciones graves (hospitalización, visita a urgencias y/o uso de glucocorticoides orales). Se ha utilizado el método de remuestreo (bootstrap) para estimar la distribución de costes y efectos en el plano coste-efectividad.

Resultados: Symbicort SMART® reduce el número de exacerbaciones graves/paciente/6 meses en un 21% (p=0,039). Los costes incrementales directos (pSNS) y totales (pS) con Symbicort SMART® en comparación con SFT fueron de −25€ (p=0,0180) y −43€ (p=0,0026), respectivamente. El coste con más influencia fue la medicación anti asmática, un 5% menor con Symbicort SMART® que con SFT (p<0.001). El ratio coste-efectividad incremental por exacerbación grave evitada de Symbicort SMART® frente a SFT fue de −739€ (pSNS) y −1.275€ (pS). Los resultados del remuestreo indican que Symbicort SMART® es una estrategia dominante en el 95,1% y 95,7% de los casos, desde la pSNS y la pS.

Conclusión: En pacientes con asma persistente, el uso de Symbicort SMART® es una terapia dominante frente a SFT, ya que disminuye significativamente el número de exacerbaciones graves con un coste directo y total menor.

Palabrasclave

análisis coste-efectividad asma budesonida/formoterol salmeterol/fluticasona terbutalina 

Abstract

Objective: To evaluate the cost-effectiveness of budesonide/formoterol two inhalations 160/4.5 μg bid plus budesonide/formoterol as-needed (Symbicort SMART®) versus one inhalation of salmeterol/fluticasone 50/500 μg bid plus terbutaline as-needed (SFT) in patients with persistent asthma from the National Health System (pNHS) and the societal perspective (pS) in Spain.

Patients and methods: Spanish unit costs (€2009) were applied to the resource use data from a 6 month randomised trial with 2,309 patients (AHEAD; Bousquet. Resp Med 2007).The effectiveness variable was the number of severe asthma exacerbations (hospitalisation/emergency room visit and/or an oral corticosteroids course). Bootstrap methods were used to estimate the distribution of costs and effectiveness in the cost-effectiveness plane.

Results: Symbicort SMART® reduced the number of severe exacerbations/patient/6 months by 21% (p=0.039). The direct (pNHS) and total costs (pS) with Symbicort SMART® were compared to SFT; −€25 (p=0.0180), −€43 (p=0.0026), respectively. The major cost component was the study drugs, which was 5% lower with Symbicort SMART® compared to SFT (p<0.001). Incremental cost per severe exacerbation avoided was −€739 (pNHS) and −€1,275 (pS). Treatment with Symbicort SMART® was a dominant strategy in 95.1% (pNHS) and 95.7% (pS) of the bootstrap replicates, respectively.

Conclusion: In patients with persistent asthma, the use of Symbicort SMART® is considered to be a dominant therapy versus SFT, achieving a significant reduction in the number of severe exacerbations at lower direct and total costs.

Keywords

cost-effectiveness analysis asthma budesonide/formoterol salmeterol/fluticasone terbutaline 

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Bibliografía

  1. 1.
    Nieto A, Alvarez-Cuesta E, Boquete M, et al. The cost of asthma treatment in Spain and rationalizing the expense. J Investig Allergol Clin Immunol. 2001;11:139–48.PubMedGoogle Scholar
  2. 2.
    Weiss KB, Sullivan SD. The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol. 2001;107:3–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Andersson F, Borg S, Ståhl E. The impact of exacerbations on the asthmatic patient’s preference scores. J Asthma 2003; 40:615–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Borderías L, Zabaleta M, Riesco JA, et al. Cost and management of asthma exacerbations in Spanish hospitals (COAX study in hospital services). Arch Bronconeumol 2005; 41:313–21.CrossRefGoogle Scholar
  5. 5.
    Braman SS. The global burden of asthma. Chest 2006;130(1 Suppl):4S–12S.PubMedCrossRefGoogle Scholar
  6. 6.
    Martínez-Moragón E, Serra-Batllés J, De Diego A, et al. Coste económico del paciente asmático en España (estudio AsmaCost). Arch Bronconeumol 2009;45:481–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Fueyo A, Ruiz MA, Ancochea J, et al. Asthma control in Spain. Do season and treatment pattern matter? Respir Med 2007;101:919–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Rabe KF, Adachi M, Lai CK, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol 2004;114:40–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2008._Disponible en: http://www.ginasthma.org
  10. 10.
    Guía Española para el manejo del asma GEMA 2009. Disponible en: http://www.guiasalud.es/GPC/GPC_304_Asma_GEMA2009.pdf
  11. 11.
    O’Byrne PM, Bisgaard H, Godard PP, et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005;171:129–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Vogelmeier C, D’Urzo A, Pauwels R, et al. Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?. Eur Respir J 2005;26:819–28.PubMedCrossRefGoogle Scholar
  13. 13.
    Rabe KF, Atienza T, Magyar P, et al. Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations: a randomised controlled, double-blind study. Lancet 2006;368:744–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Lundborg M, Wille S, Bjermer L, et al. Maintenance plus reliever budesonide/formoterol compared with a higher maintenance dose of budesonide/formoterol plus formoterol as reliever in asthma: an efficacy and cost-effectiveness study. Curr Med Res Opin 2006;22:809–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Kuna P, Peters MJ, Manjra AI, et al. Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract. 2007;61:725–36.PubMedCrossRefGoogle Scholar
  16. 16.
    Bousquet J, Boulet LP, Peters MJ, et al. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone. Respir Med 2007;101:2437–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Peters M. Single-inhaler combination therapy for maintenance and relief of asthma: a new strategy in disease management. Drugs 2009;69:137–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Johansson G, Andreasson EB, Larsson PE, et al. Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma. Pharmacoeconomics 2006;24:695–708.PubMedCrossRefGoogle Scholar
  19. 19.
    Miller E, Sears MR, McIvor A, et al. Canadian economic evaluation of budesonide-formoterol as maintenance and reliever treatment in patients with moderate to severe asthma. Can Respir J 2007;14:269–75.PubMedGoogle Scholar
  20. 20.
    Price D, Wirén A, Kuna P. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy. Allergy 2007;62:1189–98.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller E, FitzGerald JM. Budesonide/formoterol as maintenance and reliever treatment compared to fixed dose combination strategies — a Canadian economic evaluation. Can J Clin Pharmacol 2008;15:e165–76.PubMedGoogle Scholar
  22. 22.
    Sears MR, Boulet LP, Laviolette M, Fitzgerald JM, et al. Budesonide/formoterol maintenance and reliever therapy: impact on airway inflammation in asthma. Eur Respir J 2008;31:982–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Tamminen K, Laine J, Soini E, et al. Cost-effectiveness analysis of budesonide/formoterol maintenance and reliever therapy versus fixed combination treatments for asthma in Finland. Curr Med Res Opin 2008;24:3453–61.PubMedCrossRefGoogle Scholar
  24. 24.
    Consejo General de Colegios de Farmacéuticos. Catálogo de Medicamentos. Consejo Plus 2009. Madrid: Disponible en: http://www.portalfarma.com
  25. 25.
    Oblikue Consulting. Base de datos sanitarios e-salud. Disponible en: http://www.oblikue.com/bddcostes/
  26. 26.
    Ministerio de Trabajo e Inmigración. Mercado de Trabajo en España (marzo 2009). Disponible en: http://www.inem.es/inem/ciudadano/empleo/eures/pdf/EEE/ESPANA_MT_marzo_09.pdf
  27. 27.
    Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997;6:327–40.PubMedCrossRefGoogle Scholar
  28. 28.
    O’Byrne PM, Pedersen S, Lamm CJ, et al. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med 2009;179:19–24.PubMedCrossRefGoogle Scholar
  29. 29.
    Pauwels RA, Lofdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma: Formoterol and Corticosteroids Establishing Therapy (FACET) International.Study Group. N Engl J Med 1997; 337:1405–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Partridge MR, van der Molen T, Myrseth SE, et al. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med. 2006;13:6–13.Google Scholar
  31. 31.
    Balanag VM, Yunus F, Yang PC, et al. Efficacy and safety of budesonide/formoterol compared with salbutamol in the treatment of acute asthma. Pulm Pharmacol Ther 2006;19:139–47.PubMedCrossRefGoogle Scholar
  32. 32.
    Maneechotesuwan K, Essilfie-Quaye S, Meah S, et al. Formoterol attenuates neutrophilic airway inflammation in asthma. Chest 2005;128:1936–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Cleland J, Thomas M, Price D. Pharmacoeconomics of asthma treatment. Expert Opin Pharmacother 2003;4:311–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Goldfarb N, Weston C, Hartmann CW, Sikirica M, et al. Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature. Dis Manag 2004;7:61–75.PubMedCrossRefGoogle Scholar
  35. 35.
    Buxton MJ, Sullivan SD, Andersson LF, et al. Country-specific cost-effectiveness of early intervention with budesonide in mild asthma. Eur Respir J 2004;24:568–74.PubMedCrossRefGoogle Scholar
  36. 36.
    Ställberg B, Ekström T, Neij F, et al. A real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma. Respir Med 2008;102:1360–70.PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Carolina Cisneros
    • 1
  • Joaquín Quiralte
    • 2
  • Margarita Capel
    • 3
  • Miguel Ángel Casado
    • 4
  • Carl Mellstrom
    • 5
  1. 1.Hospital de la PrincesaMadridEspaña
  2. 2.Hospital Virgen del RocíoSevillaEspaña
  3. 3.Health Economics and Outcomes ResearchAstrazeneca Farmacéutica EspañaMadridEspaña
  4. 4.Pharmacoeconomics & Outcomes Research IberiaEspaña
  5. 5.AstraZeneca R&D LundSueciaEspaña

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