Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 mu g twice daily and budesonide 800 mu g twice daily in the treatment of adults and adolescents with asthma

Despite a good understanding of the disease and its treatments, asthma cont inues to place a large economic burden on healthcare systems. As such, it i s important to consider the economic impact of alternative therapeutic opti ons for the treatment of this condition to ensure that scarce resources are used in the most efficient manner possible. Thus, the aim of asthma manage ment from an economic perspective is to reduce the burden of this disease t hrough maximizing health gain with available resources. A prospective economic analysis was conducted as part of a multicentre, ran domized, double-blind, comparative trial of salmeterol/fluticasone propiona te combination product (SFC) 50/250 mu g twice daily vs. budesonide (800 mu g twice daily) in adults and adolescents with asthma who were symptomatic despite treatment with inhaled corticosteroids at doses of 800-1200 mu g da y(-1). Treatment effectiveness was measured in terms of successfully-treate d weeks, defined as a greater than or equal to 5% improvement in morning pe ak expiratory flow, episode-free days (a day without the need for rescue me dication, no nocturnal awakening or adverse events) and symptom-free days. Cost-effectiveness analyses were performed using direct healthcare and drug costs, from the perspective of the Swedish healthcare system (1998 prices) , with appropriate sensitivity analyses to test the robustness of the findi ngs. Overall, SFC produced significantly higher (P < 0.001) proportions of succe ssfully-treated weeks, episode-free days and symptom-free days. Direct asth ma management costs were similar between the two groups [SEK19.6 ($US2.4) f or SFC vs. SEK18.5 ($US2.2) for budesonide]. The cost per successfully-trea ted week was lower for SFC than for budesonide [SEK204 ($US24.8) vs. SEK300 ($US36.4) per week], as were the costs per episode-free day [SEK51.1 ($US6 .2) vs. SEK75.1 ($US9.1) per day] and symptom-free day [SEK42.2 ($US5.1) vs . SEK53.0 ($US6.4) per day]. Incremental cost-effectiveness ratios showed t hat the additional costs to achieve additional benefits with SFC were minim al. Costs per additional successfully-treated week, symptom-free day and ep isode-free day with SFC were SEK31.6 ($US3.9), SEK4.2 ($US1.1) and SEK7.7 ( $US0.9), respectively, relative to budesonide. Sensitivity analysis showed that the results were stable over a wide range of assumptions. The results suggest that SFC is a more cost-effective treatment than budesonide in the management of moderate to severe asthma.