SALMETEROL - AN APPRAISAL OF ITS QUALITY-OF-LIFE BENEFITS AND POTENTIAL PHARMACOECONOMIC POSITIONING IN ASTHMA

Salmererol is a selective beta(2)-receptor agonist with a long duratio n of action that permits twice daily administration. It is effective i n the prophylaxis of asthma symptoms, including nocturnal and exercise -induced asthma, and it has shown clinical benefits in both adults and children. Because of its slow onset of action, salmeterol is not inte nded for relief of acute symptoms. The addition of salmeterol 50 mu g twice daily to existing asthma therapy has a positive effect on patien t quality of life in the short term (up to 3 months), as assessed by t he Living With Asthma Questionnaire and Asthma Quality of Life Questio nnaire. This improvement in well-being appears to be greater than that associated with salbutamol (albuterol). Furthermore, in patients with asthma symptoms despite inhaled corticosteroid therapy, a reduced dos e of corticosteroid corticosteroid plus salmeterol produced a greater improvement in quality of life as assessed by a daily symptom diary (b ut not by the Living With Asthma Questionnaire), and was more clinical ly effective than a higher dose of corticosteroid alone. Evaluation of the effects of salmeterol on quality of life compared with other stan dard therapies, and extension of these results into the long term are required to consolidate these conclusions. Salmeterol 50 mu g twice da ily was associated with an estimated incremental cost of pound 736 per symptom-free patient in the final week of 7.5 months' therapy, pound 648 per patient with improved morning (am) peak expiratory flow rate ( PEFR) and pound 1013 per patient with improved evening (pm) PEFR compa red with salbutamol (400 mu g twice daily) in a cost-effectiveness ana lysis. However these results should be tested by sensitivity analyses and compared with the incremental costs of other asthma interventions more applicable to recommended clinical practice. The cost effectivene ss of salmeterol relative to other asthma therapies, and the effect of salmeterol on patient quality of life in the long term require furthe r investigation. However, when added to existing asthma therapy salmet erol improves patient quality of life in the short term (up to 3 month s). It may also have some beneficial effects on patient well-being whe n used to provide a steroid-sparing effect.