Cost-utility of as-needed ICS-formoterol versus to maintenance ICS in mild to moderate persistent asthma

ABSTRACT: Background: Recent asthma guidelines, such as the Global Initiative for Asthma (GINA), recommend in adult patients as-needed inhaled corticosteroids (ICS)-formoterol as an alternative to maintenance ICS in mild to moderate persistent asthma. The introduction of these recommendations concerns whether using as-needed budesonide-formoterol would be more cost-effective than to maintenance ICS. This study aimed to evaluate the cost-effectiveness of as-needed combination low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) reliever therapy in patients with mild asthma. Methods: A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with mild asthma in Colombia. Total costs and QALYs of low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results: The model suggests a potential gain of 0.37 QALYs and per patient per year on as-needed ICS-formoterol and a reduction in the discounted cost per person-year, of as-needed ICS-formoterol to maintenance ICS, of US$40. This position of dominance of as-needed ICS-formoterol negates the need to calculate an incremental cost-effectiveness ratio. In the deterministic and probabilistic sensitivity analysis, our base-case results were robust to variations in all assumptions and parameters. Conclusion: Low-dose budesonide-formoterol as a reliever was cost-effective when added to usual care in patients with mild asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

• Autores: Buendía Rodríguez, Jefferson Antonio; Guerrero Patiño, Diana
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2021
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/45146
• Acceso en línea: https://hdl.handle.net/10495/45146
• Palabra clave: Corticoesteroides - economía; Adrenal Cortex Hormones - economics; Análisis de Costo-Efectividad; Cost-Effectiveness Analysis; Asma; Asthma; Combinación Budesonida y Fumarato de Formoterol; Budesonide, Formoterol Fumarate Drug Combination; Técnicas de Apoyo para la Decisión; Decision Support Techniques; Antiasmáticos; Anti-Asthmatic Agents; Colombia; Cadenas de Markov; Markov Chains; Modelos Econométricos; Models, Econometric; Nebulizadores y Vaporizadores; Nebulizers and Vaporizers; Años de Vida Ajustados por Calidad de Vida; Quality-Adjusted Life Years; https://id.nlm.nih.gov/mesh/D000305; https://id.nlm.nih.gov/mesh/D000094703; https://id.nlm.nih.gov/mesh/D001249; https://id.nlm.nih.gov/mesh/D000069502; https://id.nlm.nih.gov/mesh/D003661; https://id.nlm.nih.gov/mesh/D018927; https://id.nlm.nih.gov/mesh/D003105; https://id.nlm.nih.gov/mesh/D008390; https://id.nlm.nih.gov/mesh/D017059; https://id.nlm.nih.gov/mesh/D009330; https://id.nlm.nih.gov/mesh/D019057
• Rights: openAccess
• License: https://creativecommons.org/licenses/by/4.0/