Inhaled salmeterol/fluticasone propionate combination - A pharmacoeconomicreview of its use in the management of asthma

Cost estimates from developed countries indicate that asthma accounts for u p to 2% of the economic cost of all diseases. A large proportion of asthma- related costs are attributable to poor asthma control. Treatment strategies which improve clinical outcomes in patients with asthma, therefore, have t he potential for significant economic benefits, and it is important to eval uate new asthma therapies for cost effectiveness. Several studies have established that salmeterol and fluticasone propionate combined in a single dry powder inhalation device are at least as effectiv e as a combination of the 2 drugs administered via separate dry powder inha lers and more effective than monotherapy with fluticasone propionate or bud esonide. Importantly, pharmacoeconomic analysis of several of these studies show that the salmeterol/fluticasone propionate combination is cost effect ive relative to monotherapy with fluticasone propionate or budesonide. Alth ough the total cost of asthma management tended to be slightly higher with salmeterol/fluticasone propionate than with inhaled corticosteroid monother apy, in most cases mean cost-effectiveness ratios were lower (i.e. more fav ourable) for salmeterol/fluticasone propionate than either fluticasone prop ionate or budesonide. Cost effectiveness was assessed according to 3 end-po ints: successfully treated weeks, symptom free days and episode-free days. Mean cost-effectiveness ratios consistently favoured salmeterol/fluticasone propionate over the comparator drug for the end-point successfully treated weeks, and in most cases the other 2 end-points also favoured the combinat ion product over the comparator. In a further study, salmeterol/fluticasone was also less costly than therapy with formoterol and budesonide administe red via 2 separate inhalers. Studies of health-related quality of life (HR-QOL) using the Asthma Quality of Life Questionnaire indicate that salmeterol/fluticasone propionate prod uces clinically meaningful improvements in overall HR-QOL relative to salme terol monotherapy or placebo. Improvements in overall HR-QOL were statistic ally significantly greater for salmeterol/fluticasone propionate than with fluticasone propionate or budesonide alone, although the differences betwee n treatments did not exceed the threshold for clinical significance. In conclusion, short term cost-effectiveness data show that salmeterol/ flu ticasone propionate is more cost effective than the inhaled corticosteroids budesonide and fluticasone propionate alone. The combination product also appears to improve HR-QOL relative to placebo or salmeterol alone.