BACKGROUND: Inhaled corticosteroids remain underused among United States-based clinicians in treating mild-to-moderate adult asthma. OBJECTIVE: The purpose of this investigation was to estimate the clinical impact, health-related quality of life, cost, and cost-effectiveness of inhaled corticosteroid therapy in a population of patients aged 18 years and over with FEV(1) = 60% to 100% of predicted normal. METHODS: We performed a cost-effectiveness analysis of quick relievers (eg, short-acting beta-agonists) on an as-needed basis plus inhaled corticosteroid therapy versus quick relievers alone. A mathematical simulation model was developed to forecast symptoms, acute exacerbations, quality-adjusted life-years (QALYs), health care costs, and cost-effectiveness, measured in both dollars per QALY gained and dollars per symptom-free day gained. All evaluation outcomes were discounted at an annual rate of 3% and measured over a 10-year planning horizon. Data on the natural history of disease, drug efficacy, patient preferences, and economic costs were obtained from a variety of observational cohorts, randomized trials, and patient surveys. RESULTS: Over a 10-year period, use of inhaled corticosteroids increases total health costs from roughly $5,200 to $8,400 and improves QALYs from 6.8 to 7.0, implying an incremental cost of $13,500 per QALY gained. Costs per symptom-free day gained are $7.50. Both per-person acute exacerbations and hospitalizations are reduced by 33%. The cost-effectiveness findings are sensitive to the assumed efficacy and side-effects of inhaled corticosteroid therapy. CONCLUSIONS: Inhaled corticosteroids appear to deliver good comparative value in adults with mild-to-moderate asthma. Although more research is needed to understand their impact on preferences regarding side effects and compliance, these findings might be useful for priority-setting in limited resource situations.
BACKGROUND: Inhaled corticosteroids remain underused among United States-based clinicians in treating mild-to-moderate adult asthma. OBJECTIVE: The purpose of this investigation was to estimate the clinical impact, health-related quality of life, cost, and cost-effectiveness of inhaled corticosteroid therapy in a population of patients aged 18 years and over with FEV(1) = 60% to 100% of predicted normal. METHODS: We performed a cost-effectiveness analysis of quick relievers (eg, short-acting beta-agonists) on an as-needed basis plus inhaled corticosteroid therapy versus quick relievers alone. A mathematical simulation model was developed to forecast symptoms, acute exacerbations, quality-adjusted life-years (QALYs), health care costs, and cost-effectiveness, measured in both dollars per QALY gained and dollars per symptom-free day gained. All evaluation outcomes were discounted at an annual rate of 3% and measured over a 10-year planning horizon. Data on the natural history of disease, drug efficacy, patient preferences, and economic costs were obtained from a variety of observational cohorts, randomized trials, and patient surveys. RESULTS: Over a 10-year period, use of inhaled corticosteroids increases total health costs from roughly $5,200 to $8,400 and improves QALYs from 6.8 to 7.0, implying an incremental cost of $13,500 per QALY gained. Costs per symptom-free day gained are $7.50. Both per-person acute exacerbations and hospitalizations are reduced by 33%. The cost-effectiveness findings are sensitive to the assumed efficacy and side-effects of inhaled corticosteroid therapy. CONCLUSIONS: Inhaled corticosteroids appear to deliver good comparative value in adults with mild-to-moderate asthma. Although more research is needed to understand their impact on preferences regarding side effects and compliance, these findings might be useful for priority-setting in limited resource situations.
Authors: Wanda Phipatanakul; Petros Koutrakis; Brent A Coull; Choong-Min Kang; Jack M Wolfson; Stephen T Ferguson; Carter R Petty; Mihail Samnaliev; Amparito Cunningham; William J Sheehan; Jonathan M Gaffin; Sachin N Baxi; Peggy S Lai; Perdita Permaul; Liming Liang; Peter S Thorne; Gary Adamkiewicz; Kasey J Brennan; Andrea A Baccarelli; Diane R Gold Journal: Contemp Clin Trials Date: 2017-06-12 Impact factor: 2.226
Authors: Ann Chen Wu; Martin Gregory; Steven Kymes; Dennis Lambert; Joshua Edler; Dustin Stwalley; Anne L Fuhlbrigge Journal: J Allergy Clin Immunol Date: 2012-09-27 Impact factor: 10.793
Authors: Ann Chen Wu; Charlene Gay; Melisa D Rett; Natasha Stout; Scott T Weiss; Anne L Fuhlbrigge Journal: Pharmacogenomics Date: 2015-04-16 Impact factor: 2.533
Authors: Helen M McTaggart-Cowan; Carlo A Marra; Yaling Yang; John E Brazier; Jacek A Kopec; J Mark FitzGerald; Aslam H Anis; Larry D Lynd Journal: Qual Life Res Date: 2008-02-15 Impact factor: 4.147
Authors: Maria Patricia Fabian; Gary Adamkiewicz; Natasha Kay Stout; Megan Sandel; Jonathan Ian Levy Journal: J Allergy Clin Immunol Date: 2013-07-31 Impact factor: 10.793
Authors: Ann C Wu; A David Paltiel; Karen M Kuntz; Scott T Weiss; Anne L Fuhlbrigge Journal: J Allergy Clin Immunol Date: 2007-09-29 Impact factor: 10.793