OBJECTIVES

: Daily inhaled corticosteroid (ICS) and long-acting beta-2-agonist combinations with as-needed relievers (short-acting beta-2-agonist - SABA) are recommended for moderate asthma. ICS-Formoterol combinations can also be used as maintenance and reliever therapy (MART). This study aims to compare direct healthcare costs in three Asian countries with costs data available; Indonesia, Thailand and Vietnam of regular twice-daily (bid) fluticasone propionate/salmeterol with as-needed SABA versus budesonide/formoterol MART.

METHODS

: Healthcare resource utilization parameters were derived from a literature review for randomized trials in adults and adolescents aged >12 years comparing regular bid fluticasone propionate/salmeterol with as-needed SABA strategy versus budesonide/formoterol MART strategy in moderate asthma. The analysis is based on the available 3 head-to-head RCTs; COSMOS (AstraZeneca study code SD-039-0691/16 countries/ 2143 patients), COMPASS (AstraZeneca study code SD-039-0735/ 16 countries/ 3335 patients), and AHEAD (NCT00242775/ 17 countries/ 2309 patients). Economic analyses were conducted from healthcare sector perspective (medication costs + healthcare utilization costs) over one year (GBP/patient/year) and referred to price in government hospitals.

RESULTS

: The differences in the exacerbation rates between the 2 strategies were small although statistically significant in favor of MART; ranging from a min. 0.04/year to max 0.14/year. Total average (min-max) costs (in GBP/ patient/ year) across the three studies were £184.96 (£131-£289), £146.29 (£110-£180), and £115.40 (£63-£147) for those who used bid fluticasone propionate/salmeterol with as-needed SABA, and £233.12 (£208-£257), £269.21 (£220-£324) and £258.87 (£218-£305) for budesonide/formoterol MART in Indonesia, Thailand and Vietnam, respectively. On average, total costs/ patient/ year with regular bid fluticasone propionate/salmeterol were 21%, 55% and 46% lower than budesonide/formoterol MART for Indonesia, Thailand and Vietnam, respectively.

CONCLUSIONS

: This study (GSK funded 213963) showed that overall, regular bid use of fluticasone propionate/salmeterol is associated with lower direct healthcare costs compared with budesonide/formoterol MART. These findings were fairly consistent across the three studies and the three countries.