Journal of Medical Economics

The cost effectiveness of eformoterol via Turbohaler® and salmeterol via pressurised metered dose inhaler and metered dose powder inhaler in mild to moderate asthma

LM Campbell MD1, F Berggren PhD3 and C Emmas PhD2 on behalf of the FORCE study group and AstraZeneca UK

1 Southbank Surgery, 17-19 Southbank Road, Kirkintilloch, Glasgow
2 AstraZeneca, Kings Langley, Herts, UK
3 AstraZeneca R&D Lund and Lund University Centre for Health Economics (LUCHE)

Keywords: eformoterol, Turbohaler, salmeterol, pMDI, Accuhaler, asthma, cost effectiveness

Summary
An economic assessment from a health service perspective was performed on data from a prospective, open, randomised, parallel group clinical trial carried out in the UK and Republic of Ireland. Patients with mild to moderate asthma were randomised to eformoterol Turbohaler® 12 µg twice daily (bd) (FT), or salmeterol 50 µg bd via either pressurised metered dose inhaler (SM) or metered dose powder inhaler (SD, Accuhaler®/Diskus®) for a period of 8 weeks. Medical costs comprised study medication; short-acting b2-agonist use; steroid medication; medication for respiratory-related side effects; additional primary care consultations; Accident and Emergency visits; and hospitalisations. Medical costs were analysed using a patient year approach and all costs are expressed in £ sterling (October 1999). The measure of effectiveness was symptom-free days (SFD) defined as days on which the patient reported no daytime symptoms, no night-time symptoms or awakenings and no use of short-acting b2-agonist to relieve symptoms.

The mean (±se) medical cost/patient/day was significantly lower for FT (�1.38±0.04) compared to both SD (£1.43±0.05; p = 0.039) and SM (£1.47±0.06; p = 0.017). The eformoterol group reported a higher percentage of SFD compared to the SD inhaler and SM groups, although this trend did not reach statistical significance. FT was more cost effective than SD with an average cost per SFD 41% higher for SD (£5.94) and 25% higher for SM (£5.26) compared with FT (£4.22). Sensitivity analyses further confirmed these findings.

The addition of FT 12 ±g bd to patients' existing asthma therapy is more cost effective than SD 50 ±g bd or SM 50 mcg bd for the management of mild to moderate asthma.