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Cost effectiveness of budesonide/formoterol in a single inhaler for COPD compared with each monocomponent used alone

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Abstract

Objective: To compare the healthcare costs and effects of budesonide/formoterol in a single inhaler with those of budesonide and formoterol monotherapies, and placebo, in a multinational study in patients with chronic obstructive pulmonary disease (COPD), National Heart, Lung and Blood Institute (NHLBI)/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV. Previous analysis of the clinical data from the study had shown that budesonide/formoterol was associated with better lung function and improved health-related QOL compared with the monocomponents or placebo and lower frequency of exacerbations compared with formoterol and placebo.

Method: Patients (n = 1022) were randomised to twice-daily treatment with two inhalations of budesonide/formoterol (160μg/4.5μg) in a single inhaler, budesonide 200μg, formoterol 4.5μg or placebo for 12 months. Data on medication and healthcare use were combined with Swedish unit cost data to estimate the total annual healthcare cost per patient from the Swedish healthcare payer perspective. Costs were valued in Swedish kronor (SEK) [2001 values] and converted to euros (SEK1 = €0.11, 25th April 2003).

Results: This evaluation estimated the total annual healthcare costs per patient to be numerically lower for budesonide/formoterol (€2518) than for budesonide (€3194), formoterol (€3653) or placebo (€3213). Cost-effectiveness acceptability curves suggest that budesonide/formoterol may be cost effective compared with formoterol, even if the decision maker is not willing to pay anything for the additional clinical effects, and that budesonide/formoterol is cost effective compared with placebo if a decision maker is willing to pay about €2 per day, per avoided exacerbation.

Conclusion: This economic analysis suggests that the clinical benefits of using budesonide/formoterol in a single inhaler are achieved at a numerically lower total healthcare cost than either monocomponent or placebo. Budesonide/formoterol in patients with severe COPD (GOLD stages III or IV) may be cost effective, from the healthcare provider perspective, compared with either monocomponent.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

  2. Symbicort Turbuhaler® 160/4.5 µg delivers the same amount of budesonide and formoterol as the corresponding Turbuhaler® mono products.

References

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349: 1498–504

    Article  PubMed  CAS  Google Scholar 

  2. Vermeire P. The burden of chronic obstructive pulmonary disease. Respir Med 2002; 96 Suppl. C: S3–S10

    Article  PubMed  Google Scholar 

  3. Stavem K, Lossius MI, Kvien TK, et al. The health-related quality of life of patients with epilepsy, compared with angina pectoris, rheumatoid arthritis, asthma and chronic obstructive pulmonary disease. Qual Life Res 2000; 9: 865–71

    Article  PubMed  CAS  Google Scholar 

  4. National Heart, Lung, and Blood Institute. Chronic obstructive pulmonary disease (COPD) data fact sheet. Bethesda (MD): NIH Publication No. 03-5229, 2003

  5. Jansson S-A, Andersson F, Borg S, et al. Costs of COPD in Sweden according to disease severity. Chest 2002; 122: 1994–2002

    Article  PubMed  Google Scholar 

  6. Grasso ME, Weller WE, Shaffer TJ, et al. Capitation, managed care and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 133–8

    PubMed  CAS  Google Scholar 

  7. Strassels SA, Smith DH, Sullivan SD, et al. The costs of treating COPD in the United States. Chest 2001; 119: 344–52

    Article  PubMed  CAS  Google Scholar 

  8. Niederman MS, McCombs IS, Unger AN, et al. Treatment cost of acute exacerbations of chronic bronchitis. Clin Ther 1999; 21: 576–91

    Article  PubMed  CAS  Google Scholar 

  9. Cydulka RK, McFadden Jr ER, Emerman CL, et al. Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 156: 1807–12

    PubMed  CAS  Google Scholar 

  10. Connors Jr AF, Dawson NV, Thomas C, et al. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Outcomes following acute exacerbation of severe chronic obstructive lung disease [published erratum appears in Am J Respir Crit Care Med 1997; 155 (1): 386]. Am J Respir Crit Care Med 1996; 154: 959–67

    PubMed  Google Scholar 

  11. Andersson F, Borg S, Jansson S-A, et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002; 96: 700–8

    Article  PubMed  CAS  Google Scholar 

  12. Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418–22

    PubMed  CAS  Google Scholar 

  13. Global Initiative for Chronic Obstructive Lung Disease. Bethesda (MD): National Institutes of Health: National Heart, Lung, and Blood Institute, 2001 (2003 update). NIH publication No. 2701

  14. Szafranski W, Cukier A, Ramirez A, et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Fur Respir J 2003; 21: 74–81

    Article  CAS  Google Scholar 

  15. Ward MM, Javitz HS, Smith WM, et al. Direct medical cost of chronic obstructive pulmonary disease in the USA. Respir Med 2000; 94: 1123–9

    Article  PubMed  CAS  Google Scholar 

  16. Calverley PM, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Fur Respir J 2003; 22: 912–9

    Article  CAS  Google Scholar 

  17. Swedish Pharmacopoeia 2001. FASS - läkemedel i Sverige, LINFO Läkemedelsinfomation AB, Stockholm, 2001

  18. Rutten-van Mölken MP, van Doorslaer EK, van Vliet RC. Statistical analysis of cost outcomes in a randomized controlled clinical trial. Health Econ 1994; 3: 333–45

    Article  PubMed  Google Scholar 

  19. MEDTAP Database of international unit costs for economic evaluation in health care. London: MEDTAP International Inc, 1999

  20. Regionala priser och ersattningar 2001 för södra sjukvårdsregionen (Prices and payments 2001 for the Southern health region) [online]. Available from URL: http://www.srvn.org/ prislista.htm [Accessed 2004 Aug 1]

  21. Prislista år 2001 f6r Norrlands universitetssjukhus (Pricelist year 2001 for the University hospital in the north of Sweden) [online]. Available from URL: http://www.norrlandstingen.nu/nuspri03utgl.xis [Accessed 2004 Aug 1]

  22. Andersson F, Kjellman M, Forsberg G, et al. Comparison of the cost-effectiveness of budesonide and sodium cromoglycate in the management of childhood asthma in everyday clinical practice. Ann Allergy Asthma Immunol 2001; 86: 537–44

    Article  PubMed  CAS  Google Scholar 

  23. Hjortsberg C, Svarvar P. IHE arbetsrapport (working paper). Lund: The Swedish Institute for Health Economics, 1999: 2

    Google Scholar 

  24. Västra Götalands regionen, Sahlgrenska universitetssjukhuset, Öppenvårdspriser 2002. Personal contact. Prices outpatients care Sahlgrenska, University Hospital, West Sweden, 2002

  25. Briggs AH, Gray AM. Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess 1999; 3: 1–134

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors wish to thank Bengt Liljas and Fredrik Andersson for considerable contribution in the writing of this manuscript. Claes-Göran Löfdahl was the medical advisor for the trial and was involved in the study design. Åsa Ericsson and Emma Andreasson are health economists who designed the study, undertook the economic analyses and produced a first outline for everyone’s review. Klas Svensson was the statistician for the study. Apart from these specific points, all authors contributed equally to and approved the final manuscript.

Åsa Ericsson, Klas Svensson and Emma Andreasson are all AstraZeneca employees. Claes-Göran Löfdahl has received lecture fees from each of the major pharmaceutical companies in the respiratory area (AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis) and has also received institutional grants from AstraZeneca, GlaxoSmithKline and Novartis.

The study was supported by a grant from AstraZeneca.

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Authors and Affiliations

  1. Department of Respiratory Medicine and Allergology, Lund University Hospital, Lund, S-22185, Sweden

    Claes-Göran Löfdahl

  2. AstraZeneca R&D, Lund, Sweden

    Åsa Ericsson, Klas Svensson & Emma Andreasson

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  1. Claes-Göran Löfdahl
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  2. Åsa Ericsson
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  3. Klas Svensson
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  4. Emma Andreasson
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Correspondence to Claes-Göran Löfdahl.

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Löfdahl, CG., Ericsson, Å., Svensson, K. et al. Cost effectiveness of budesonide/formoterol in a single inhaler for COPD compared with each monocomponent used alone. Pharmacoeconomics 23, 365–375 (2005). https://doi.org/10.2165/00019053-200523040-00006

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  • DOI: https://doi.org/10.2165/00019053-200523040-00006

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