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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

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PharmacoEconomics Spanish Research Articles

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.

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.

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Authors and Affiliations

  1. Hospital de la Princesa, Madrid, España

    Carolina Cisneros

  2. Hospital Virgen del Rocío, Sevilla, España

    Joaquín Quiralte

  3. Health Economics and Outcomes Research, Astrazeneca Farmacéutica España, Madrid, España

    Margarita Capel

  4. Pharmacoeconomics & Outcomes Research Iberia, C/ Segundo Mata 1 28224 Pozuelo de Alarcón., España

    Miguel Ángel Casado

  5. AstraZeneca R&D Lund, Suecia, España

    Carl Mellstrom

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  1. Carolina Cisneros
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  2. Joaquín Quiralte
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  4. Miguel Ángel Casado
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Correspondence to Miguel Ángel Casado.

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Cisneros, C., Quiralte, J., Capel, M. et al. 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. Pharmacoecon. Span. Res. Artic. 7, 163–175 (2010). https://doi.org/10.1007/BF03321485

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