Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic trial

Edward C. F. Wilson, David Price, Stanley D. Musgrave, Erika J. Sims, Lee Shepstone, Jamie Murdoch, H. Miranda Mugford, Annie Blyth, Elizabeth F. Juniper, Jon G. Ayres, Stephanie Wolfe, Daryl Freeman, Richard F. T. Gilbert, Elizabeth V. Hillyer, Ian Harvey

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Information is lacking on the relative effectiveness and cost effectiveness – in a primary-care setting – of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy.

Objective: To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy.

Methods: An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12–80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n¿=¿326) were randomly assigned to LTRAs (n¿=¿162) or ICS (n¿=¿164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives.

Results: Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at £711 versus £433 for the ICS group (adjusted difference £204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of £30¿000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives.

Conclusions: There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy.

Trial registration: UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
Original languageEnglish
Pages (from-to)597-608
Number of pages12
JournalPharmacoeconomics
Volume28
Issue number7
DOIs
Publication statusPublished - 1 Jul 2010

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Pragmatic Clinical Trials
Leukotriene Antagonists
Cost-Benefit Analysis
Adrenal Cortex Hormones
Asthma
Quality-Adjusted Life Years
Costs and Cost Analysis
Drug Costs
Therapeutics
Primary Health Care
Prescription Drugs
Controlled Clinical Trials
Health Care Costs
Anti-Inflammatory Agents
Randomized Controlled Trials
Quality of Life
Outcome Assessment (Health Care)

Keywords

  • administration, inhalation
  • adolescent
  • adrenal cortex hormones
  • adrenergic beta-agonists
  • adult
  • aged
  • aged, 80 and over
  • asthma
  • child
  • cost-benefit analysis
  • delayed-action preparations
  • drug therapy, combination
  • Great Britain
  • humans
  • leukotriene antagonists
  • middle aged
  • quality-adjusted life years
  • questionnaires
  • receptors, adrenergic, beta-2
  • treatment outcome
  • young adult
  • asthma, treatment
  • beta-adrenergic-receptor-agonists, therapeutic use
  • corticosteroids, therapeutic use
  • cost-effectiveness
  • cost-utility
  • leukotriene-D4-receptor-antagonists, therapeutic use

Cite this

Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma : a pragmatic trial. / Wilson, Edward C. F.; Price, David; Musgrave, Stanley D.; Sims, Erika J.; Shepstone, Lee; Murdoch, Jamie; Mugford, H. Miranda; Blyth, Annie; Juniper, Elizabeth F.; Ayres, Jon G.; Wolfe, Stephanie; Freeman, Daryl; Gilbert, Richard F. T.; Hillyer, Elizabeth V.; Harvey, Ian.

In: Pharmacoeconomics, Vol. 28, No. 7, 01.07.2010, p. 597-608.

Research output: Contribution to journalArticle

Wilson, ECF, Price, D, Musgrave, SD, Sims, EJ, Shepstone, L, Murdoch, J, Mugford, HM, Blyth, A, Juniper, EF, Ayres, JG, Wolfe, S, Freeman, D, Gilbert, RFT, Hillyer, EV & Harvey, I 2010, 'Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic trial', Pharmacoeconomics, vol. 28, no. 7, pp. 597-608. https://doi.org/10.2165/11537560-000000000-00000
Wilson, Edward C. F. ; Price, David ; Musgrave, Stanley D. ; Sims, Erika J. ; Shepstone, Lee ; Murdoch, Jamie ; Mugford, H. Miranda ; Blyth, Annie ; Juniper, Elizabeth F. ; Ayres, Jon G. ; Wolfe, Stephanie ; Freeman, Daryl ; Gilbert, Richard F. T. ; Hillyer, Elizabeth V. ; Harvey, Ian. / Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma : a pragmatic trial. In: Pharmacoeconomics. 2010 ; Vol. 28, No. 7. pp. 597-608.
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T1 - Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma

T2 - a pragmatic trial

AU - Wilson, Edward C. F.

AU - Price, David

AU - Musgrave, Stanley D.

AU - Sims, Erika J.

AU - Shepstone, Lee

AU - Murdoch, Jamie

AU - Mugford, H. Miranda

AU - Blyth, Annie

AU - Juniper, Elizabeth F.

AU - Ayres, Jon G.

AU - Wolfe, Stephanie

AU - Freeman, Daryl

AU - Gilbert, Richard F. T.

AU - Hillyer, Elizabeth V.

AU - Harvey, Ian

PY - 2010/7/1

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N2 - Background: Information is lacking on the relative effectiveness and cost effectiveness – in a primary-care setting – of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy. Objective: To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy. Methods: An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12–80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n¿=¿326) were randomly assigned to LTRAs (n¿=¿162) or ICS (n¿=¿164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives. Results: Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at £711 versus £433 for the ICS group (adjusted difference £204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of £30¿000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives. Conclusions: There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy. Trial registration: UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.

AB - Background: Information is lacking on the relative effectiveness and cost effectiveness – in a primary-care setting – of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy. Objective: To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy. Methods: An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12–80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n¿=¿326) were randomly assigned to LTRAs (n¿=¿162) or ICS (n¿=¿164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives. Results: Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at £711 versus £433 for the ICS group (adjusted difference £204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of £30¿000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives. Conclusions: There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy. Trial registration: UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.

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KW - adrenal cortex hormones

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KW - aged

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KW - delayed-action preparations

KW - drug therapy, combination

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KW - quality-adjusted life years

KW - questionnaires

KW - receptors, adrenergic, beta-2

KW - treatment outcome

KW - young adult

KW - asthma, treatment

KW - beta-adrenergic-receptor-agonists, therapeutic use

KW - corticosteroids, therapeutic use

KW - cost-effectiveness

KW - cost-utility

KW - leukotriene-D4-receptor-antagonists, therapeutic use

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