To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ACAAI: Single-unit Combination Therapy Might Be Most Cost-effective for Persistent Asthma URL: http://www.pslgroup.com/dg/23EE32.htm Doctor's Guide November 19, 2003
By Paula Moyer NEW ORLEANS, LA -- November 19, 2003 -- A single-unit combination therapy consisting of a corticosteroid and a long-acting beta-agonist is more cost-effective than other prophylactic therapies used to treat asthma, according to findings presented here November 9th at the American College of Allergy, Asthma, and Immunology Annual Meeting. The primary single-unit combination therapy currently consists of the corticosteroid fluticasone propionate (Flovent) and the long-acting beta-agonist salmeterol (Serevent). This single-unit combination was compared with other prophylactic asthma therapies, including corticosteroids and leukotriene modifiers. "This decision-analysis model showed that [combined fluticasone and salmeterol] may be the most cost-effective therapy in patients with persistent asthma," noted Tina Shih, PhD, associate professor of biostatistics and applied mathematics, M.D. Anderson Cancer Center, Houston, Texas, United States. The parameters the investigators considered included days without asthma symptoms and days without the need to use "rescue therapies," or treatments for acute exacerbations. The investigators wanted to see which prophylactic modality, among first-line asthma controller therapies, was the most cost-effective. They therefore reviewed efficacy and health-care utilisation data from several randomised controlled trials. The agents they studied included the combination of fluticasone and salmeterol, fluticasone monotherapy, all other inhaled corticosteroids, and leukotriene modifiers. The investigators used a 1-year time frame and pooled efficacy and health-care utilisation data from published clinical trials, as well as published observational studies and expert opinions. The investigators compared the percentage of symptom-free days and rescue-medication-free days experienced by the patients taking the respective treatments. To adjust for differences in patients' baseline demographic characteristics, the efficacy associated with the placebo group was normalised to reflect the overall efficacy difference between the placebo and treatment groups. Because most trials were 12 weeks long, the investigators incorporated into their analysis assumptions about therapy switches, compliance, the relationship between compliance and efficacy, and withdrawals. The investigative team used a panel consisting of 3 pulmonologists and 2 allergists to evaluate the assumptions in their analysis. The investigators then performed a sensitivity analysis to assess the results' strength. They found that over a 1-year period the single-unit combination of fluticasone and salmeterol was the most cost-effective therapy, associated with a cost of $3.11 per symptom-free day and $2.33 per rescue-free day. For fluticasone monotherapy, the cost per symptom-free day was $3.33 and the cost per rescue-medication-free day was $2.37. For other inhaled corticosteroids, those rates were $3.42 and $2.42 respectively; for leukotriene modifiers, the rates were $4.62 and $3.40 respectively. The additional cost for achieving an incremental efficacy using the combination therapy was $1.80 per symptom-free day and $1.91 per rescue-free day compared with fluticasone monotherapy. Compared with other inhaled corticosteroids, the additional cost for the combination was $1.84 per symptom-free day and $1.92 per rescue-free day. When the combination was compared with leukotriene modifiers, the relationship was actually negative. Dr. Shih stated that this finding suggests that the combination may be less expensive. When she and her colleagues conducted sensitivity analyses, the findings showed that the results were most sensitive to the assumptions made about the pattern of switching after discontinuing the initial treatment. [Study Title: Cost-Efficacy Decision Analytic Model for First-Line Controller Therapies for Patients with Persistent Asthma. Abstract P78] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.