The cost-effectiveness of as-needed budesonide/formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in the UK

FitzGerald, J. Mark; Arnetorp, Sofie; Smare, Caitlin; Gibson, Danny; Coulton, Karen; Hounsell, Kirsty; Golam, Sarowar; Sadatsafavi, Mohsen

doi:10.1016/j.rmed.2020.106079

Cited by 19 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this economic evaluation, as-needed budesonideformoterol was the dominant treatment option compared with low-dose maintenance ICS therapy plus as-needed SABA in patients with mild asthma over a 50-year time horizon from a Canadian public payer perspective, with costs savings of $9882 per patient. These findings support those of a cost-effectiveness analysis from the UK healthcare payer perspective, which made similar treatment comparisons based on SYGMA 2 data [25]. An important finding in both the SYGMA 1 and SYGMA 2 studies is observed treatment adherence.…”

Section: Discussionsupporting

confidence: 82%

“…On the basis of this evidence, budesonide-formoterol as anti-inflammatory reliever therapy was approved in Canada in September 2019 for patients aged ≥ 12 years with mild persistent asthma [23,24]. A recent study found that as-needed budesonide-formoterol is costeffective versus maintenance ICS plus as-needed SABA from a UK healthcare payer's perspective [25], but this strategy has not been assessed from a Canadian perspective.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

Sadatsafavi

FitzGerald

O’Byrne

et al. 2021

Allergy Asthma Clin Immunol

Self Cite

View full text Add to dashboard Cite

Background The Global Initiative for Asthma recommends the use of as-needed low-dose inhaled corticosteroid (ICS)-formoterol as a preferred controller therapy for patients with mild asthma. These recommendations were based, in part, on evidence from the SYGMA 1 and 2 studies of as-needed budesonide-formoterol. This analysis aimed to compare the cost-effectiveness of as-needed budesonide-formoterol to low-dose maintenance ICS plus as-needed short-acting β2-agonist (SABA) in patients with mild asthma. Methods A Markov cohort model was designed that included three possible health states (non-exacerbation, severe exacerbation, and death) to compare as-needed budesonide-formoterol 200–6 μg to twice-daily budesonide 200 μg maintenance therapy (low-dose ICS) plus as-needed terbutaline 0.5 mg (SABA). The deterministic base-case analysis used severe exacerbation, adverse event (AE), and healthcare resource use data from SYGMA 2, and was conducted from a Canadian public payer perspective with a 50-year time horizon, and a discount rate of 1.5% per annum. Moderate exacerbation was modelled on data from SYGMA 1 in sensitivity analyses. Utility values were derived from SYGMA 2 quality of life data. All-cause- and asthma-related mortality rates and costs (reported in 2019 Canadian dollars) were based on published data, using Canada-specific values where available. One-way deterministic sensitivity, probabilistic sensitivity, and eight scenario analyses were conducted to examine the robustness of the results. Results As-needed budesonide-formoterol was the dominant treatment option in the base-case analysis, providing incremental cost savings of $9882 per patient and quality-adjusted life year (QALY) gains of 0.002 versus low-dose maintenance ICS plus as-needed SABA over a 50-year time horizon. Using a willingness-to-pay threshold of $50,000/QALY ($100,000/QALY), as-needed budesonide-formoterol had a 94% (95%) probability of being cost-effective compared with maintenance ICS plus as-needed SABA. Cost-saving was mostly driven by lower overall medication and AE-related costs. As-needed budesonide-formoterol remained the dominant treatment in sensitivity and scenario analyses. Conclusions As-needed budesonide-formoterol is a cost-saving option for the treatment of mild asthma from the perspective of the Canadian public payer compared with low-dose maintenance ICS plus as-needed SABA.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

Sadatsafavi

FitzGerald

O’Byrne

et al. 2021

Allergy Asthma Clin Immunol

Self Cite

View full text Add to dashboard Cite

show abstract

“…5 Cost-effectiveness acceptability curve (real-world setting). CE cost effectiveness, SABA short-acting β 2 -agonist perspective of the UK payer [32]. That study reported budesonide/formoterol PRN to be a dominant intervention, with a cost saving of £292.99 and a quality-adjusted lifeyear (QALY) gained of 0.001 when compared with maintenance budesonide.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of budesonide/formoterol (Symbicort®) as needed for mild asthma in Malaysia

Gopal¹,

Thani²,

Tan³

et al. 2021

Drugs Ther Perspect

View full text Add to dashboard Cite

Background Budesonide/formoterol (Symbicort ® ) as needed (PRN) is effective for the prevention of severe exacerbations in mild asthma. Objective This economic model evaluated the cost effectiveness of budesonide/formoterol PRN versus (1) a short-acting β 2 -agonist (SABA) PRN and (2) maintenance budesonide plus SABA PRN for mild asthma in Malaysia. Methods A decision analytical model was developed to evaluate the downstream economic consequences of the comparators from the payer's perspective (i.e. Ministry of Health, Malaysia) with a fixed time horizon of 1 year, and no discounting was applied. Data were derived from published clinical trials (i.e. SYGMA 1, SYGMA 2, and Novel START), the latest Malaysian resources, and an expert panel. The incremental cost-effectiveness ratio (ICER) per severe exacerbation avoided was determined. Sensitivity and scenario analyses were conducted to examine the robustness of the model. Results Treatment with budesonide/formoterol PRN (Malaysian ringgit [RM]773.39) had a lower total annual cost than SABA PRN (RM908.27) but a slightly higher cost than maintenance budesonide (RM760.51). The main cost driver was the disease management cost. Budesonide/formoterol PRN was a dominant intervention compared with SABA PRN and was associated with an ICER of RM696.11 per severe exacerbation avoided compared with maintenance budesonide. Scenario analysis with data from the Novel START trial indicated that budesonide/formoterol PRN was a dominant intervention compared with both SABA PRN and maintenance budesonide. Model outcomes were most affected by the mean inhalation of budesonide/formoterol PRN, the cost of managing severe exacerbations in hospital, and the probability of severe exacerbations with maintenance budesonide. Conclusion From the Malaysian healthcare payer perspective, budesonide/formoterol PRN is either a dominant or likely to be a cost-effective treatment option in managing mild asthma.

show abstract

“…The cost of one budesonide/formoterol device is much more than an albuterol inhaler ($437.26 vs $74.02, which could limit real world generalizability and affordability [18,19]. The price of budesonide/formoterol, however, is similar to that of budesonide alone ($300-500), and budesonide/formoterol as needed was found to be a cost-effective alternative compared to low-dose ICS [20,21]. The cost of an emergency department visit related to asthma is approximately $1400, and the higher cost of asthma medications has been correlated with better asthma control and significantly lower total asthma costs [21][22][23].…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

“…The price of budesonide/formoterol, however, is similar to that of budesonide alone ($300-500), and budesonide/formoterol as needed was found to be a cost-effective alternative compared to low-dose ICS [20,21]. The cost of an emergency department visit related to asthma is approximately $1400, and the higher cost of asthma medications has been correlated with better asthma control and significantly lower total asthma costs [21][22][23]. The mean daily dose of ICS was lower in patients receiving budesonide/formoterol as needed compared to budesonide maintenance.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

Walsh¹,

Forinash²,

Stauffer³

et al. 2021

Med Clin Res Open Access

View full text Add to dashboard Cite

Objective: To summarize literature assessing the safety and efficacy of budesonide/formoterol, a low dose inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used as needed for the treatment of adult patients with mild persistent asthma requiring step 2 therapy compared to low dose inhaled corticosteroid (ICS) plus short-acting beta agonist (SABA) and SABA monotherapy. Data Sources: A literature search of PubMed (1966-October 2020), EMBASE (1973-October 2020) and clinicaltrials.gov was conducted using the following search terms: budesonide, formoterol, as needed, and mild asthma. Study selection and data extraction: Randomized, controlled trials with data describing as needed use of budesonide-formoterol in the treatment of mild, persistent asthma were included. Data synthesis: Current trials demonstrate a reduced risk of exacerbation and an improvement in symptom control in patients receiving budesonide/formoterol as needed when compared to as needed SABA alone. However, when compared to scheduled budesonide maintenance, patients receiving budesonide/formoterol as needed experienced worse symptom control and mixed exacerbation results. Relevance to patient care and clinical practice: This review evaluates the efficacy and safety of budesonide/formoterol as needed for patients with mild asthma. The Global Initiative for Asthma (GINA), a global strategy for asthma management and prevention adopted this change in 2019, and the most recent updated Expert Panel Report 4 of the National Asthma Education and Prevention Program (NAEPP) did not address this area. Conclusions: Based on this review of the literature, further study is needed to determine the place in therapy for budesonide/formoterol as needed in the treatment of mild persistent asthma. Low-dose ICS should remain the standard of therapy in patients with mild asthma requiring Step 2 therapy.

show abstract

The cost-effectiveness of as-needed budesonide/formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in the UK

Cited by 19 publications

References 26 publications

The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

Cost-effectiveness analysis of budesonide/formoterol (Symbicort®) as needed for mild asthma in Malaysia

Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

Contact Info

Product

Resources

About