Cost-effectiveness analysis of budesonide/formoterol under SMART® therapy versus fixed-dose fluticasone/salmeterol for the treatment of patients with moderate-tosevere persistent asthma

Análisis de costo-efectividad budesonida/formoterol bajo terapia SMART® versus fluticasona/salmeterol en dosis fijas, para el tratamiento de pacientes con asma persistente moderada a grave

Objetive: to compare the cost-effectiveness of budesonide/formoterol under SMART® therapy (160/4,5 μg one inhalation every 12 hours) versus fluticasone/salmeterol at fixed dose (25/125 μg two inhalations every 12 hours), in the management of patients with moderate persistent and severe persistent asthma, or who are at the third therapeutic step.

Methods: cost-effectiveness was assessed through a Markov model that simulated the clinical stages of a patient with asthma, over a time horizon of one year and with a hypothetic cohort of 100 patients. Cost-effectiveness was assessed by taking avoided hospitalizations and months free from severe exacerbations as outcomes. The uses and costs related with each stage were calculated from the perspective of a third-party payer, beginning with information obtained from the databases of Colombian insurance service providers, at 2013 prices, and validated by specialists. An univariate and multivariate probabilistic sensitivity analysis was carried out.

Results: SMART therapy reduced the number of hospitalizations by 5,7 with regard to fixed-dose salmeterol/fluticasone therapy. The number of months free of exacerbations for such therapy was 1.127, whereas that of salmeterol/fluticasone was 1.087.

Conclusion: the use of budesonide/formoterol under SMART therapy reduces the total costs of management and maintenance, which significantly reduces the number of hospitalizations and increases the months without exacerbations. Thus, this treatment mode proves to be a more cost-effective option than salmeterol/fluticasone in the Colombian context.