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Cost Justified for Early Use of Steroids in Asthma: Presented at ACAAI
By Roberta Friedman
Special to DG News
SAN ANTONIO, TX -- November 15, 2002 -- Early use of inhaled steroids is worth the price for asthmatics, said investigators reporting Steroid Treatment as Regular Theray (START) trial data here today at the meeting of the American College of Allergy, Asthma, and Immunology (AAAAI).
Cost analysis of data from the START trial shows that budesonide use early on in mild, persistent asthma, cuts the economic fallout from treating acute episodes. Investigator Sean Sullivan, PhD., said the study outcome "confirms that if we intervene early, with very effective treatment, it has a positive economic outcome," even though adding inhaled steroid use adds costs.
START "justifies continuing reimbursement" for use of inhaled budesonide, said Sullivan, professor of pharmacy, public health, and community medicine at the University of Washington in Seattle. Cost of asthma in the United States has doubled in the last decade, Sullivan said, and that is primarily due to treatment failures. START found that it costs $223 to gain 14 symptom free days per year, in U.S. currency.
In terms of payers, the added cost of budesonide use is $11.30 per symptom-free day. But from a societal perspective, factoring in lost school and work days, the cost drops to $3.70.
For the children aged 5 to 10 years in the trial, the economic analysis showed a cost benefit, Sullivan said.
Budesonide group patients had 69 percent fewer days of hospital stay, 67 percent fewer visits to emergency departments, and 36 percent fewer contacts with the health care system. In addition, they lost 37 percent fewer days from school and work. All of the values were statistically significant, due to the power of the large trial. START enrolled more than 7000 patients in 32 countries, whose mild, persistent asthma was of less than two years duration.
Cost analyses for the other participating countries also showed benefits. Sullivan said that the cost needed to improve asthma care is comparable to the primary prevention costs for other diseases such as hypertension.
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