Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist

Nicolas Roche; Gene Colice; Elliot Israel; Richard J. Martin; Paul M. Dorinsky; Dirkje S. Postma; Theresa W. Guilbert; Jonathan Grigg; Willem M. C. van Aalderen; Francesca Barion; Elizabeth V. Hillyer; Victoria Thomas; Anne Burden; R. Brett McQueen; David B. Price

doi:10.1007/s41030-016-0014-2

Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist

Nicolas Roche, Gene Colice, Elliot Israel, Richard J. Martin, Paul M. Dorinsky, Dirkje S. Postma, Theresa W. Guilbert, Jonathan Grigg, Willem M. C. van Aalderen, Francesca Barion, Elizabeth V. Hillyer, Victoria Thomas, Anne Burden, R. Brett McQueen, David B. Price

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Abstract

Introduction

Data from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy.

Methods

This was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12–80 years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β2-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection).

Results

Patients prescribed ICS dose step-up (n = 3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA (n = 3036; mean difference, £124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of £51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up (n = 3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers (n = 6464).

Conclusion

For asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints.

Original language	English
Pages (from-to)	73-89
Number of pages	17
Journal	Pulmonary Therapy
Volume	2
Issue number	1
Early online date	21 Mar 2016
DOIs	https://doi.org/10.1007/s41030-016-0014-2
Publication status	Published - Jun 2016

Keywords

asthma
Beclometasone dipropionate hydrofluoroalkane
Budesonide/formoterol fumarate dehydrate
cost-effectivness
extrafine-particle inhaled corticosteroid
fixed-dose combination inhalers
fluticasone propionate/salmeterol xinafoate
long-acting β2-agonist

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Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist
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Cite this

Roche, N., Colice, G., Israel, E., Martin, R. J., Dorinsky, P. M., Postma, D. S., Guilbert, T. W., Grigg, J., van Aalderen, W. M. C., Barion, F., Hillyer, E. V., Thomas, V., Burden, A., Brett McQueen, R., & Price, D. B. (2016). Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist. Pulmonary Therapy, 2(1), 73-89. https://doi.org/10.1007/s41030-016-0014-2

Roche, N, Colice, G, Israel, E, Martin, RJ, Dorinsky, PM, Postma, DS, Guilbert, TW, Grigg, J, van Aalderen, WMC, Barion, F, Hillyer, EV, Thomas, V, Burden, A, Brett McQueen, R & Price, DB 2016, 'Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist', Pulmonary Therapy, vol. 2, no. 1, pp. 73-89. https://doi.org/10.1007/s41030-016-0014-2

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title = "Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist",

abstract = "IntroductionData from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy.MethodsThis was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12–80 years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β2-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection).ResultsPatients prescribed ICS dose step-up (n = 3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA (n = 3036; mean difference, £124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of £51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up (n = 3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers (n = 6464).ConclusionFor asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints.",

keywords = "asthma, Beclometasone dipropionate hydrofluoroalkane , Budesonide/formoterol fumarate dehydrate , cost-effectivness, extrafine-particle inhaled corticosteroid, fixed-dose combination inhalers, fluticasone propionate/salmeterol xinafoate, long-acting β2-agonist ",

author = "Nicolas Roche and Gene Colice and Elliot Israel and Martin, {Richard J.} and Dorinsky, {Paul M.} and Postma, {Dirkje S.} and Guilbert, {Theresa W.} and Jonathan Grigg and {van Aalderen}, {Willem M. C.} and Francesca Barion and Hillyer, {Elizabeth V.} and Victoria Thomas and Anne Burden and {Brett McQueen}, R. and Price, {David B.}",

note = "The analyses were funded by an unrestricted grant from Teva Pharmaceuticals Limited of Petach Tikva, Israel. Access to data from the Optimum Patient Care Research Database was co-funded by Research in Real-Life Ltd (RiRL), Cambridge, UK. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors thank Julie von Ziegenweidt for assistance with data extraction.",

year = "2016",

month = jun,

doi = "10.1007/s41030-016-0014-2",

language = "English",

volume = "2",

pages = "73--89",

journal = "Pulmonary Therapy",

issn = "2364-1746",

publisher = "Springer ",

number = "1",

}

TY - JOUR

T1 - Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist

AU - Roche, Nicolas

AU - Colice, Gene

AU - Israel, Elliot

AU - Martin, Richard J.

AU - Dorinsky, Paul M.

AU - Postma, Dirkje S.

AU - Guilbert, Theresa W.

AU - Grigg, Jonathan

AU - van Aalderen, Willem M. C.

AU - Barion, Francesca

AU - Hillyer, Elizabeth V.

AU - Thomas, Victoria

AU - Burden, Anne

AU - Brett McQueen, R.

AU - Price, David B.

N1 - The analyses were funded by an unrestricted grant from Teva Pharmaceuticals Limited of Petach Tikva, Israel. Access to data from the Optimum Patient Care Research Database was co-funded by Research in Real-Life Ltd (RiRL), Cambridge, UK. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors thank Julie von Ziegenweidt for assistance with data extraction.

PY - 2016/6

Y1 - 2016/6

N2 - IntroductionData from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy.MethodsThis was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12–80 years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β2-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection).ResultsPatients prescribed ICS dose step-up (n = 3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA (n = 3036; mean difference, £124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of £51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up (n = 3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers (n = 6464).ConclusionFor asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints.

AB - IntroductionData from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy.MethodsThis was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12–80 years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β2-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection).ResultsPatients prescribed ICS dose step-up (n = 3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA (n = 3036; mean difference, £124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of £51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up (n = 3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers (n = 6464).ConclusionFor asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints.

KW - asthma

KW - Beclometasone dipropionate hydrofluoroalkane

KW - Budesonide/formoterol fumarate dehydrate

KW - cost-effectivness

KW - extrafine-particle inhaled corticosteroid

KW - fixed-dose combination inhalers

KW - fluticasone propionate/salmeterol xinafoate

KW - long-acting β2-agonist

U2 - 10.1007/s41030-016-0014-2

DO - 10.1007/s41030-016-0014-2

M3 - Article

VL - 2

SP - 73

EP - 89

JO - Pulmonary Therapy

JF - Pulmonary Therapy

SN - 2364-1746

IS - 1

ER -

Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist

Abstract

Keywords

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