Skip to main content
SpringerLink
Log in

An economic evaluation of budesonide/formoterol for maintenance and reliever treatment in asthma in general practice

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

In budesonide/formoterol (Symbicort® Turbuhaler®, AstraZeneca, Lund, Sweden) maintenance and reliever therapy (SMART), patients with asthma take a daily maintenance dose of budesonide/formoterol, with the option of taking additional doses for symptom relief instead of a short-acting β2-agonist (SABA). This study assesses the cost-effectiveness of SMART compared with usual care in patients with mild-to-moderate persistent asthma treated by general practitioners in the Netherlands from a societal perspective.

Methods

The study was linked to a randomized, active-controlled, open-label, multicenter, 12-month clinical trial, with a prospective collection of resource use. One hundred and two patients ≥18 years with mild-to-moderate persistent asthma and daily inhaled corticosteroids (ICS) prior to the trial were included. SMART was given as two inhalations of budesonide/formoterol (100/6 μg) once daily, plus additional doses as needed. The control group was treated according to guidelines, which prescribe medium daily doses of ICS plus an SABA if needed. A long-acting β2-agonist (LABA) is added if necessary. Effectiveness was measured as the proportion of asthma-control days, Asthma Control Questionnaire (ACQ) scores, the net proportion of patients with relevant ACQ improvement, and the proportion of well-controlled patients. Costs included asthma medication, physician contacts, and absence from work.

Results

Mean total costs for SMART were €134.81 lower (95% CI: −€439.48; €44.85). Production losses were €94.10 (95% CI: −€300.60; €0.29) lower for SMART (€10.77 vs. €104.87). No significant differences in health outcomes were seen, with 3.81 fewer asthma-control days per patient-year for SMART (95% CI: −36.8; 30.8), a 0.049 better ACQ score (95% CI: −0.21; 0.29), a 5.8% larger net proportion of improved patients (95% CI: t15.6%; 27.3%), and a 2.1% (95% CI: −25.5; 20.8%) smaller increase in the proportion of well-controlled patients.

Conclusions

Treating primary care patients with mild-to-moderate persistent asthma with SMART instead of ICS plus bronchodilators does not affect health outcomes and does not increase costs; therefore, is likely to be an alternative for guideline-directed treatment, from a health and economic perspective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Global Initiative for Asthma web site. GINA Report, Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma 2008. Available at: www.ginasthma.com. Accessed August 2009.

  2. Kips JC, O’Connor BJ, Inman MD, Svensson K, Pauwels RA, O’Byrne PM. A long-term study of the antiinflammatory effect of low-dose budesonide plus formoterol versus high-dose budesonide in asthma. Am J Respir Crit Care Med. 2000;161:996–1001.

    CAS  PubMed  Google Scholar 

  3. Lalloo UG, Malolepszy J, Kozma D, et al. Budesonide and formoterol in a single inhaler improves asthma control compared with increasing the dose of corticosteroid in adults with mild-to-moderate asthma. Chest. 2003;123:1480–1487.

    Article  CAS  PubMed  Google Scholar 

  4. Stoloff SW, Stempel DA, Meyer J, Stanford RH, Carranza Rosenzweig JR. Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies. J Allergy Clin Immunol. 2004;113:245–251.

    Article  PubMed  Google Scholar 

  5. O’Byrne PM, Bisgaard H, Godard PP, et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med. 2005;171:129–136.

    Article  PubMed  Google Scholar 

  6. Rabe KF, Atienza T, Magyar P, Larsson P, Jorup C, Lalloo UG. Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations: a randomised controlled, doubleblind study. Lancet. 2006;368:744–753.

    Article  CAS  PubMed  Google Scholar 

  7. Rabe KF, Pizzichini E, Stallberg B, et al. Budesonide/formoterol in a single inhaler for maintenance and relief in mild-to-moderate asthma: a randomized, double-blind trial. Chest. 2006;129:246–256.

    Article  CAS  PubMed  Google Scholar 

  8. Scicchitano R, Aalbers R, Ukena D, et al. Efficacy and safety of budesonide/formoterol single inhaler therapy versus a higher dose of budesonide in moderate to severe asthma. Curr Med Res Opin. 2004;20:1403–1418.

    Article  CAS  PubMed  Google Scholar 

  9. Vogelmeier C, D’Urzo A, Pauwels R, et al. Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option? Eur Respir J. 2005;26:819–828.

    Article  CAS  PubMed  Google Scholar 

  10. Johansson G, Andreasson EB, Larsson PE, Vogelmeier CF. Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma. Pharmacoeconomics. 2006;24:695–708.

    Article  CAS  PubMed  Google Scholar 

  11. Lundborg M, Wille S, Bjermer L, et al. Maintenance plus reliever budesonide/formoterol compared with a higher maintenance dose of budesonide/formoterol plus formoterol as reliever in asthma: an efficacy and cost-effectiveness study. Curr Med Res Opin. 2006;22:809–821.

    Article  CAS  PubMed  Google Scholar 

  12. Price D, Wiren A, Kuna P. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy. Allergy. 2007;62:1189–1198.

    Article  CAS  PubMed  Google Scholar 

  13. Miller E, Sears MR, McIvor A, Liovas A. Canadian economic evaluation of budesonide-formoterol as maintenance and reliever treatment in patients with moderate to severe asthma. Can Respir J. 2007;14:269–275.

    PubMed  Google Scholar 

  14. Ställberg B, Ekstrom T, Neij F, et al. A real-life costeffectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma. Respir Med. 2008;102:1360–1370.

    Article  PubMed  Google Scholar 

  15. Geijer RMM, Chavannes NH, Muris JWM, et al. NHG Standaard Astma bij volwassenen. Huisarts en Wetenschap. 2007;11:537–551.

    Google Scholar 

  16. Juniper EF, O’Byrne PM, Roberts JN. Measuring asthma control in group studies: do we need airway calibre and rescue beta2-agonist use? Respir Med. 2001;95:319–323.

    Article  CAS  PubMed  Google Scholar 

  17. Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14:902–907.

    Article  CAS  PubMed  Google Scholar 

  18. Campbell JL, Kiebert GM, Partridge MR. Development of the satisfaction with inhaled asthma treatment questionnaire. Eur Respir J. 2003;22:127–134.

    Article  CAS  PubMed  Google Scholar 

  19. Guyatt GH, Juniper EF, Walter SD, Griffith LE, Goldstein RS. Interpreting treatment effects in randomised trials. BMJ. 1998;316:690–693.

    CAS  PubMed  Google Scholar 

  20. Juniper EF, Bousquet J, Abetz L, Bateman ED, GOAL Committee. Identifying “well-controlled” and “not well-controlled” asthma using the Asthma Control Questionnaire. Respir Med. 2006;100:616–621.

    Article  PubMed  Google Scholar 

  21. Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH. Guide to cost research - Methods and standard costs prices for economic evaluatons in healthcare [in Dutch]. Amstelveen: College voor zorgverzekeringen (Health Care Insurance Board); 2004.

    Google Scholar 

  22. Health Care Insurance Board. Available at: www.medicijnkosten.nl (Medication costs). Accessed September 10, 2007.

  23. Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327–340.

    Article  CAS  PubMed  Google Scholar 

  24. Campbell MK, Torgerson DJ. Bootstrapping: estimating confidence intervals for cost-effectiveness ratios. QJM. 1999;92:177–182.

    Article  CAS  PubMed  Google Scholar 

  25. DiCiccio TJ, Efron B. Bootstrap confidence intervals. Stat Sci. 1996;11:189–228.

    Article  Google Scholar 

  26. Briggs A, Fenn P. Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ. 1998;7:723–740.

    Article  CAS  PubMed  Google Scholar 

  27. Briggs AH, O’Brien BJ. The death of costminimization analysis? Health Econ. 2001;10:179–184.

    Article  CAS  PubMed  Google Scholar 

  28. Al MJ, van Hout BA, Michel BC, Rutten FF. Sample size calculation in economic evaluations. Health Econ. 1998;7:327–335.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Medical Technology Assessment, Erasmus University Medical Center, P.O. Box 1738, 3000, DR Rotterdam, The Netherlands

    Lucas M. A. Goossens & Maureen P. M. H. Rutten-van Mölken

  2. Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands

    Roland A. Riemersma & Thys van der Molen

  3. Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands

    Dirkje S. Postma

Authors
  1. Lucas M. A. Goossens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roland A. Riemersma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dirkje S. Postma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thys van der Molen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maureen P. M. H. Rutten-van Mölken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucas M. A. Goossens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goossens, L.M.A., Riemersma, R.A., Postma, D.S. et al. An economic evaluation of budesonide/formoterol for maintenance and reliever treatment in asthma in general practice. Adv Therapy 26, 872–885 (2009). https://doi.org/10.1007/s12325-009-0063-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-009-0063-0

Keywords

Search

Navigation