The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

• Published in: Allergy, asthma, and clinical immunology Vol. 17; no. 1; p. 108
• Main Authors: Sadatsafavi, Mohsen, FitzGerald, J Mark, O'Byrne, Paul M, Soliman, Mena, Sriskandarajah, Niroshan, Vicente, Colin, Golam, Sarowar Muhammad
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-10-2021; BioMed Central; BMC
• Subjects: Analysis; Anti-inflammatory reliever; As-needed; Asthma; Budesonide-formoterol; Canada; Corticosteroids; Cost analysis; Cost-effectiveness; Dosage and administration; Drug prices; Economic aspects; Health care policy; Inhalers; Low income groups; Mild asthma; Mortality; Ontario; Patients; Pharmaceutical industry; Quality of life; Sensitivity analysis; Steroids; Terbutaline; Canada; Ontario; As-needed; Mild asthma; Budesonide-formoterol; Cost-effectiveness; Anti-inflammatory reliever
• ISSN: 1710-1484; 1710-1492; 1710-1492
• DOI: 10.1186/s13223-021-00610-w

The Global Initiative for Asthma recommends the use of as-needed low-dose inhaled corticosteroid (ICS)-formoterol as a preferred controller therapy for patients with mild asthma. These recommendations were based, in part, on evidence from the SYGMA 1 and 2 studies of as-needed budesonide-formoterol. This analysis aimed to compare the cost-effectiveness of as-needed budesonide-formoterol to low-dose maintenance ICS plus as-needed short-acting β
-agonist (SABA) in patients with mild asthma.
A Markov cohort model was designed that included three possible health states (non-exacerbation, severe exacerbation, and death) to compare as-needed budesonide-formoterol 200-6 μg to twice-daily budesonide 200 μg maintenance therapy (low-dose ICS) plus as-needed terbutaline 0.5 mg (SABA). The deterministic base-case analysis used severe exacerbation, adverse event (AE), and healthcare resource use data from SYGMA 2, and was conducted from a Canadian public payer perspective with a 50-year time horizon, and a discount rate of 1.5% per annum. Moderate exacerbation was modelled on data from SYGMA 1 in sensitivity analyses. Utility values were derived from SYGMA 2 quality of life data. All-cause- and asthma-related mortality rates and costs (reported in 2019 Canadian dollars) were based on published data, using Canada-specific values where available. One-way deterministic sensitivity, probabilistic sensitivity, and eight scenario analyses were conducted to examine the robustness of the results.
As-needed budesonide-formoterol was the dominant treatment option in the base-case analysis, providing incremental cost savings of $9882 per patient and quality-adjusted life year (QALY) gains of 0.002 versus low-dose maintenance ICS plus as-needed SABA over a 50-year time horizon. Using a willingness-to-pay threshold of $50,000/QALY ($100,000/QALY), as-needed budesonide-formoterol had a 94% (95%) probability of being cost-effective compared with maintenance ICS plus as-needed SABA. Cost-saving was mostly driven by lower overall medication and AE-related costs. As-needed budesonide-formoterol remained the dominant treatment in sensitivity and scenario analyses.
As-needed budesonide-formoterol is a cost-saving option for the treatment of mild asthma from the perspective of the Canadian public payer compared with low-dose maintenance ICS plus as-needed SABA.