Economic Evaluation of the Fixed Dose Combination of Indacaterol/ Glycopyrromium, as a Maintenance Bronchodilator Treatment in Adult Mexican Patients With COPD

Abstract

Objectives: To analyze ambulatory prescribing practice and to assess the costeffectiveness of asthma pharmacotherapy in country settings. MethOds: It is a prospective prescribing practice and cost-effectiveness analysis. During 2008-2011 were observed 238 patients in Plovdiv region and collected information about their ambulatory asthma pharmacotherapy. Prescribed medicines were systematized in INN groups of mono and fixed dose combination products. The FEO1 and percentage of patients without exacerbation were used as measure of the therapeutic results. Incremental cost-effectiveness ratio was calculated and with Tornado diagram was explored the sensitivity of the results. Results: Pharmacotherapy with fixed dose combination was performed mainly with Beclomethazone/formoterol; Budesonide/ formoterol; and Salmeterol/fluticasone. The monthly cost of pharmacotherapy is varying among 35 and 50 Euro. Incremental cost effectiveness ratio is favoring the combination Beclomethazone/ formoterol 100/6 mcg with ICER of 324 Euro for additional increase in FEO1, and 50 Euro ICER for additional patient without exacerbation, although all alternatives are cost-effective because all ICERs fall below the GDP per capita. The monotherapy was performed with Beclomethazone, Fluticasone, Budesonide, Ciclesonide, and Montelukast. Its monthly cost was among 19 and 40 Euro. Incremental cost effectiveness ratio is favoring ciclesonide that is a dominant alternative as monotherapy for both studies outcomes. Results are sensitive to the changes in therapeutic outcomes. cOnclusiOns: The real life therapy follows the international guidelines but less fixed dose combinations were prescribed in comparison with international recommendations. Beclomethazone/ formoterol fixed dose combination and ciclesonide as monotherapy are cost-effective alternatives for the observed health care settings.