Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol

a retrospective matched observational study of real-world patients

David Price, Iain Small, John Haughney, Dermot Ryan, Kevin Gruffydd-Jones, Federico Lavorini, Tim Harris, Annie Burden, Jeremy Brockman, Christine King, Alberto Papi

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Efficacy trials suggest that extra-fine particle beclometasone dipropionate-formoterol (efBDP-FOR) is comparable to fluticasone propionate-salmeterol (FP-SAL) in preventing asthma exacerbations at a clinically equivalent dosage. However, switching from FP-SAL to efBDP-FOR has not been evaluated in real-world asthma patients.

AIMS: The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR.

METHODS: A retrospective matched (1:3) observational study of 1,528 asthma patients aged 18-80 years from clinical practice databases was performed. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non-inferiority (at least equivalence) of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.

RESULTS: efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)). Switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean -130μg/day FP equivalents; p<0.001). It also reduced mean asthma-related healthcare costs by £93.63/patient/year (p<0.001).

CONCLUSIONS: Asthma patients may be switched from FP-SAL to efBDP-FOR at an equivalent or lower ICS dosage with no reduction in clinical effectiveness but a significant reduction in cost.

Original languageEnglish
Pages (from-to)439-448
Number of pages10
JournalPrimary Care Respiratory Journal
Volume22
Issue number4
Early online date2 Nov 2013
DOIs
Publication statusPublished - Dec 2013

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Beclomethasone
Cost-Benefit Analysis
Observational Studies
Asthma
Adrenal Cortex Hormones
Salmeterol Xinafoate Drug Combination Fluticasone Propionate
Formoterol Fumarate
Albuterol
Nebulizers and Vaporizers
Health Care Costs
Hospitalization
Steroids
Economics
Databases
Costs and Cost Analysis

Keywords

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Albuterol
  • Androstadienes
  • Anti-Asthmatic Agents
  • Asthma
  • Beclomethasone
  • Cost-Benefit Analysis
  • Drug Combinations
  • Drug Costs
  • Drug Substitution
  • Ethanolamines
  • Female
  • Health Care Costs
  • Health Services
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Cite this

Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol : a retrospective matched observational study of real-world patients. / Price, David; Small, Iain; Haughney, John; Ryan, Dermot; Gruffydd-Jones, Kevin; Lavorini, Federico; Harris, Tim; Burden, Annie; Brockman, Jeremy; King, Christine; Papi, Alberto.

In: Primary Care Respiratory Journal, Vol. 22, No. 4, 12.2013, p. 439-448.

Research output: Contribution to journalArticle

Price, David ; Small, Iain ; Haughney, John ; Ryan, Dermot ; Gruffydd-Jones, Kevin ; Lavorini, Federico ; Harris, Tim ; Burden, Annie ; Brockman, Jeremy ; King, Christine ; Papi, Alberto. / Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol : a retrospective matched observational study of real-world patients. In: Primary Care Respiratory Journal. 2013 ; Vol. 22, No. 4. pp. 439-448.
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abstract = "BACKGROUND: Efficacy trials suggest that extra-fine particle beclometasone dipropionate-formoterol (efBDP-FOR) is comparable to fluticasone propionate-salmeterol (FP-SAL) in preventing asthma exacerbations at a clinically equivalent dosage. However, switching from FP-SAL to efBDP-FOR has not been evaluated in real-world asthma patients.AIMS: The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR.METHODS: A retrospective matched (1:3) observational study of 1,528 asthma patients aged 18-80 years from clinical practice databases was performed. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non-inferiority (at least equivalence) of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.RESULTS: efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95{\%} CI 0.74 to 1.37)). Switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean -130μg/day FP equivalents; p<0.001). It also reduced mean asthma-related healthcare costs by £93.63/patient/year (p<0.001).CONCLUSIONS: Asthma patients may be switched from FP-SAL to efBDP-FOR at an equivalent or lower ICS dosage with no reduction in clinical effectiveness but a significant reduction in cost.",
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author = "David Price and Iain Small and John Haughney and Dermot Ryan and Kevin Gruffydd-Jones and Federico Lavorini and Tim Harris and Annie Burden and Jeremy Brockman and Christine King and Alberto Papi",
note = "Funding: The study was sponsored by Chiesi UK Ltd. The funders had no role in the conduct of the study, interpretation of study results, or preparation of the manuscript.",
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TY - JOUR

T1 - Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol

T2 - a retrospective matched observational study of real-world patients

AU - Price, David

AU - Small, Iain

AU - Haughney, John

AU - Ryan, Dermot

AU - Gruffydd-Jones, Kevin

AU - Lavorini, Federico

AU - Harris, Tim

AU - Burden, Annie

AU - Brockman, Jeremy

AU - King, Christine

AU - Papi, Alberto

N1 - Funding: The study was sponsored by Chiesi UK Ltd. The funders had no role in the conduct of the study, interpretation of study results, or preparation of the manuscript.

PY - 2013/12

Y1 - 2013/12

N2 - BACKGROUND: Efficacy trials suggest that extra-fine particle beclometasone dipropionate-formoterol (efBDP-FOR) is comparable to fluticasone propionate-salmeterol (FP-SAL) in preventing asthma exacerbations at a clinically equivalent dosage. However, switching from FP-SAL to efBDP-FOR has not been evaluated in real-world asthma patients.AIMS: The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR.METHODS: A retrospective matched (1:3) observational study of 1,528 asthma patients aged 18-80 years from clinical practice databases was performed. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non-inferiority (at least equivalence) of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.RESULTS: efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)). Switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean -130μg/day FP equivalents; p<0.001). It also reduced mean asthma-related healthcare costs by £93.63/patient/year (p<0.001).CONCLUSIONS: Asthma patients may be switched from FP-SAL to efBDP-FOR at an equivalent or lower ICS dosage with no reduction in clinical effectiveness but a significant reduction in cost.

AB - BACKGROUND: Efficacy trials suggest that extra-fine particle beclometasone dipropionate-formoterol (efBDP-FOR) is comparable to fluticasone propionate-salmeterol (FP-SAL) in preventing asthma exacerbations at a clinically equivalent dosage. However, switching from FP-SAL to efBDP-FOR has not been evaluated in real-world asthma patients.AIMS: The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR.METHODS: A retrospective matched (1:3) observational study of 1,528 asthma patients aged 18-80 years from clinical practice databases was performed. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non-inferiority (at least equivalence) of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.RESULTS: efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)). Switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean -130μg/day FP equivalents; p<0.001). It also reduced mean asthma-related healthcare costs by £93.63/patient/year (p<0.001).CONCLUSIONS: Asthma patients may be switched from FP-SAL to efBDP-FOR at an equivalent or lower ICS dosage with no reduction in clinical effectiveness but a significant reduction in cost.

KW - Administration, Inhalation

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Albuterol

KW - Androstadienes

KW - Anti-Asthmatic Agents

KW - Asthma

KW - Beclomethasone

KW - Cost-Benefit Analysis

KW - Drug Combinations

KW - Drug Costs

KW - Drug Substitution

KW - Ethanolamines

KW - Female

KW - Health Care Costs

KW - Health Services

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Treatment Outcome

KW - Young Adult

U2 - 10.4104/pcrj.2013.00088

DO - 10.4104/pcrj.2013.00088

M3 - Article

VL - 22

SP - 439

EP - 448

JO - Primary Care Respiratory Journal

JF - Primary Care Respiratory Journal

SN - 1475-1534

IS - 4

ER -