Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study

Richard J Martin, David Price, Nicolas Roche, Elliot Israel, Willem Mc van Aalderen, Jonathan Grigg, Dirkje S Postma, Theresa W Guilbert, Elizabeth V Hillyer, Anne Burden, Julie von Ziegenweidt, Gene Colice

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Abstract

BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.

AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).

METHODS: These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.

RESULTS: In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95% confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95% CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98% probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100% probabilities in the US.

CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.

Original languageEnglish
Article number14081
Journalnpj Primary Care Respiratory Medicine
Volume24
Early online date9 Oct 2014
DOIs
Publication statusPublished - 2014

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Particle Size
Cost-Benefit Analysis
Adrenal Cortex Hormones
Cohort Studies
Asthma
Delivery of Health Care
Confidence Intervals
Therapeutics
Beclomethasone
Costs and Cost Analysis
United Kingdom
Respiratory Tract Infections
Hospitalization
Odds Ratio
Steroids
Demography
Databases
Anti-Bacterial Agents

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Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems : a retrospective matched cohort study. / Martin, Richard J; Price, David; Roche, Nicolas; Israel, Elliot; van Aalderen, Willem Mc; Grigg, Jonathan; Postma, Dirkje S; Guilbert, Theresa W; Hillyer, Elizabeth V; Burden, Anne; von Ziegenweidt, Julie; Colice, Gene.

In: npj Primary Care Respiratory Medicine, Vol. 24, 14081, 2014.

Research output: Contribution to journalArticle

Martin, RJ, Price, D, Roche, N, Israel, E, van Aalderen, WM, Grigg, J, Postma, DS, Guilbert, TW, Hillyer, EV, Burden, A, von Ziegenweidt, J & Colice, G 2014, 'Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study', npj Primary Care Respiratory Medicine, vol. 24, 14081. https://doi.org/10.1038/npjpcrm.2014.81
Martin, Richard J ; Price, David ; Roche, Nicolas ; Israel, Elliot ; van Aalderen, Willem Mc ; Grigg, Jonathan ; Postma, Dirkje S ; Guilbert, Theresa W ; Hillyer, Elizabeth V ; Burden, Anne ; von Ziegenweidt, Julie ; Colice, Gene. / Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems : a retrospective matched cohort study. In: npj Primary Care Respiratory Medicine. 2014 ; Vol. 24.
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title = "Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study",
abstract = "BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).METHODS: These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.RESULTS: In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95{\%} confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95{\%} CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98{\%} probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100{\%} probabilities in the US.CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.",
author = "Martin, {Richard J} and David Price and Nicolas Roche and Elliot Israel and {van Aalderen}, {Willem Mc} and Jonathan Grigg and Postma, {Dirkje S} and Guilbert, {Theresa W} and Hillyer, {Elizabeth V} and Anne Burden and {von Ziegenweidt}, Julie and Gene Colice",
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T1 - Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems

T2 - a retrospective matched cohort study

AU - Martin, Richard J

AU - Price, David

AU - Roche, Nicolas

AU - Israel, Elliot

AU - van Aalderen, Willem Mc

AU - Grigg, Jonathan

AU - Postma, Dirkje S

AU - Guilbert, Theresa W

AU - Hillyer, Elizabeth V

AU - Burden, Anne

AU - von Ziegenweidt, Julie

AU - Colice, Gene

N1 - We thank Professor Neil Barnes for his contributions to the early discussions when planning the analyses.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).METHODS: These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.RESULTS: In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95% confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95% CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98% probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100% probabilities in the US.CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.

AB - BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).METHODS: These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.RESULTS: In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95% confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95% CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98% probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100% probabilities in the US.CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.

U2 - 10.1038/npjpcrm.2014.81

DO - 10.1038/npjpcrm.2014.81

M3 - Article

C2 - 25297072

VL - 24

JO - npj Primary Care Respiratory Medicine

JF - npj Primary Care Respiratory Medicine

SN - 2055-1010

M1 - 14081

ER -