Initiating or changing to a fixed-dose combination of fluticasone propionate/formoterol over fluticasone propionate/salmeterol: a real-life effectiveness and cost impact evaluation

Simon Wan Yau Ming, John Haughney, Iain Small, Stephanie Wolfe, John Hamill, Kevin Gruffydd-Jones, Cathal Daly, Joan B Soriano, Elizabeth Gardener, Derek Skinner, Martina Stagno d'Alcontres, David B. Price

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Asthma has a substantial impact on quality of life and health care resources. The identification of a more cost-effective, yet equally efficacious, treatment could positively influence the economic burden of this disease. Fluticasone propionate/Formoterol (FP/FOR) may be as effective as Fluticasone Salmeterol (FP/SAL). We evaluated non-inferiority of asthma control in terms of the proportion of patients free from exacerbations, and conducted a cost impact analysis.


This historical, matched cohort database study evaluated two treatment groups in the Optimum Patient Care Research Database in the UK: 1) an FP/FOR cohort of patients initiating treatment with FP/FOR or changing from FP/SAL to FP/FOR and; 2) an FP/SAL cohort comprising patients initiating, or remaining on FP/SAL pMDI combination therapy. The main outcome evaluated non-inferiority of effectiveness (defined as prevention of severe exacerbations, lower limit of the 95% confidence interval (CI) of the mean difference between groups in patient proportions with no exacerbations is −3.5% or higher) in patients treated with FP/FOR versus FP/SAL.


After matching 1:3, we studied a total of 2472 patients: 618 in the FP/FOR cohort (174 patients initiated on FP/FOR and 444 patients changed to FP/FOR) and 1854 in the FP/SAL cohort (522 patients initiated FP/SAL and 1332 continued FP/SAL). The percentage of patients prescribed FP/FOR met non-inferiority as the adjusted mean difference in proportion of no severe exacerbations (95%CI) was 0.008 (−0.032, 0.047) between the two cohorts. No other significant differences were observed except acute respiratory event rates, which were lower for patients prescribed FP/FOR (rate ratio [RR] 0.82, 95% CI 0.71, 0.94).


Changing to, or initiating FP/FOR combination therapy, is associated with a non-inferior proportion of patients who are severe exacerbation-free at a lower average annual cost compared with continuing or initiating treatment with FP/SAL.
Original languageEnglish
Pages (from-to)199-206
Number of pages8
JournalRespiratory Medicine
Early online date24 Jun 2017
Publication statusPublished - Aug 2017



  • Asthma
  • Cost-effectiveness
  • Fixed-dose combination inhalers
  • Formoterol
  • GINA
  • Real-life

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