Cost‐utility analysis of daily versus intermittent inhaled corticosteroids in mild‐persistent asthma

Abstract

Summary Introduction Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies. Methods A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable “quality-adjusted life-years” (QALYs). Results For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US $437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant. Conclusions The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs. Pediatr Pulmonol.

Economic evaluation of interventions for the treatment of asthma in children: A systematic review

“…Most of the 18 studies included originated from the United States, followed by the UK, Colombia, the Netherlands, Canada, Germany, Hong Kong, and Venezuela (Appendix ).…”

“…Two studies assessed a mixed population, although only the results restricted to pediatric patients were considered. The asthma type and severity of the included studies differed, including allergic, persistent, acute, and chronic asthma.…”

Does the use of efficacy or effectiveness evidence in cost-effectiveness analysis matter?

“…Four studies (16%) did not report any funding sources. Most of the CEA studies using effectiveness evidence (7/8, 87.5%) (7,15,16,22,25,31) reported that the interventions were cost-effective, while only 4 out of 9 (44.4%) (18,20,28,32) CEA studies using efficacy evidence were cost-effective.…”

Pediatric pulmonology year in review 2015: Part 3

“…Limiting inhaled corticosteroids in asthmatic children to the dose needed to achieve good clinical outcome while minimizing side effects is an important goal, and has given rise to investigation of intermittent dosing strategies . Rodriguez‐Martinez et al found that treating patients with recurrent wheezing or mild persistent asthma with daily inhaled corticosteroids results in higher gain in quality adjusted life years (QALY) compared to intermittent treatment . Sidoroff et al reported that regular inhaled corticosteroid use for longer than 6 months in children aged less than 6 years was associated with decreased bone mineral density in the lumbar spine; the amount of the cumulative dose until age 12 was correlated with the amount of decrease in femoral bone mineral density .…”

“…17 Rodriguez-Martinez et al found that treating patients with recurrent wheezing or mild persistent asthma with daily inhaled corticosteroids results in higher gain in quality adjusted life years (QALY) compared to intermittent treatment. 18 Sidoroff et al reported that regular inhaled corticosteroid use for longer than 6 months in children aged less than 6 years was associated with decreased bone mineral density in the lumbar spine; the amount of the cumulative dose until age 12 was correlated with the amount of decrease in femoral bone mineral density. 19 Petsky et al studied asthmatic children randomized to use of fractional exhaled nitric oxide (FeNO) monitoring as a treatment guide, and found that use of FeNO was associated with decreased severe exacerbations.…”