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

Research output: Contribution to journalArticle

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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
Volume129
Early online date24 Jun 2017
DOIs
Publication statusPublished - Aug 2017

Fingerprint

Cost-Benefit Analysis
Confidence Intervals
Costs and Cost Analysis
Salmeterol Xinafoate Drug Combination Fluticasone Propionate
Fluticasone
flutiform
Therapeutics
Databases
Cost of Illness
Quality of Health Care
Health Resources
Respiratory Rate
Patient Care
Cohort Studies
Asthma
Quality of Life

Keywords

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

Cite this

Initiating or changing to a fixed-dose combination of fluticasone propionate/formoterol over fluticasone propionate/salmeterol : a real-life effectiveness and cost impact evaluation. / Ming, Simon Wan Yau ; Haughney, John; Small, Iain; Wolfe, Stephanie; Hamill, John; Gruffydd-Jones, Kevin; Daly, Cathal; Soriano, Joan B; Gardener, Elizabeth; Skinner, Derek; d'Alcontres, Martina Stagno; Price, David B.

In: Respiratory Medicine, Vol. 129, 08.2017, p. 199-206.

Research output: Contribution to journalArticle

Ming, Simon Wan Yau ; Haughney, John ; Small, Iain ; Wolfe, Stephanie ; Hamill, John ; Gruffydd-Jones, Kevin ; Daly, Cathal ; Soriano, Joan B ; Gardener, Elizabeth ; Skinner, Derek ; d'Alcontres, Martina Stagno ; Price, David B. / Initiating or changing to a fixed-dose combination of fluticasone propionate/formoterol over fluticasone propionate/salmeterol : a real-life effectiveness and cost impact evaluation. In: Respiratory Medicine. 2017 ; Vol. 129. pp. 199-206.
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title = "Initiating or changing to a fixed-dose combination of fluticasone propionate/formoterol over fluticasone propionate/salmeterol: a real-life effectiveness and cost impact evaluation",
abstract = "ObjectiveAsthma 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.MethodsThis 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.ResultsAfter 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).ConclusionsChanging 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.",
keywords = "Asthma, Cost-effectiveness, Fixed-dose combination inhalers, Formoterol, GINA, Real-life",
author = "Ming, {Simon Wan Yau} and John Haughney and Iain Small and Stephanie Wolfe and John Hamill and Kevin Gruffydd-Jones and Cathal Daly and Soriano, {Joan B} and Elizabeth Gardener and Derek Skinner and d'Alcontres, {Martina Stagno} and Price, {David B.}",
note = "With institutional support from NAPP Pharmaceutical Group Ltd. 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 and have given final approval to the version to be published. The authors would like to thank Rosalind Bonomally for medical writing support.",
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TY - JOUR

T1 - Initiating or changing to a fixed-dose combination of fluticasone propionate/formoterol over fluticasone propionate/salmeterol

T2 - a real-life effectiveness and cost impact evaluation

AU - Ming, Simon Wan Yau

AU - Haughney, John

AU - Small, Iain

AU - Wolfe, Stephanie

AU - Hamill, John

AU - Gruffydd-Jones, Kevin

AU - Daly, Cathal

AU - Soriano, Joan B

AU - Gardener, Elizabeth

AU - Skinner, Derek

AU - d'Alcontres, Martina Stagno

AU - Price, David B.

N1 - With institutional support from NAPP Pharmaceutical Group Ltd. 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 and have given final approval to the version to be published. The authors would like to thank Rosalind Bonomally for medical writing support.

PY - 2017/8

Y1 - 2017/8

N2 - ObjectiveAsthma 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.MethodsThis 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.ResultsAfter 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).ConclusionsChanging 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.

AB - ObjectiveAsthma 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.MethodsThis 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.ResultsAfter 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).ConclusionsChanging 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.

KW - Asthma

KW - Cost-effectiveness

KW - Fixed-dose combination inhalers

KW - Formoterol

KW - GINA

KW - Real-life

U2 - 10.1016/j.rmed.2017.06.016

DO - 10.1016/j.rmed.2017.06.016

M3 - Article

VL - 129

SP - 199

EP - 206

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -