Source: Annual Congress 2002 - Asthma - Therapy and management -1
Disease area: Airway diseases, Paediatric lung diseases

Abstract

There is increasing evidence that early intervention with inhaled corticosteroids (ICS) improves outcomes for persons with mild persistent asthma. We estimated the cost-effectiveness of early use of budesonide (Pulmicort® Turbuhaler® 200 or 400 μg O.D.) in newly diagnosed asthma using data from the START trial.
Methods: Cost-effectiveness analysis of a 3-year, multi-national, randomized, controlled trial. Data were from 7165 patients aged 5 to 66 years. Three age groups were studied separately and overall: 5-10 years, 11-17 years, and 18+ years. The primary outcome measure was frequency of symptom-free days (SFD). Costs (in 1999 US$) included regular and emergency health care, medications, and costs of days missed from school/work. Incremental cost-effectiveness ratios (ICER) were estimated as cost per SFD gained.
Results: When compared to usual care, which could include use of ICS, budesonide patients experienced an annual average of 14 more SFDs (p<0.001), reduced hospital days (p<0.001), and reduced emergency-room visits (p<0.05). These benefits were achieved at a mean daily net cost to the health care system of $0.42, which translated into an ICER of $11.30 (95% CI: $8.6 to 14.9) per SFD gained. Including the reduced days absent from school/work (p<0.001), a societal perspective, gives a lower mean daily net cost of $0.14 (ICER of $3.7 per SFD gained, 95% CI: $0.1 to 8). The ICER was most favorable in the youngest age group.
Conclusion: The cost per SFD suggests that early intervention with budesonide might be considered cost-effective in mild persistent asthma, and cost-saving in children.

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S. D. Sullivan, M. Buxton, L. F. Andersson, C. J. Lamm, B. Liljas, Y. Z. Chen, R. A. Pauwels, K. B. Weiss (Seattle, Chicago, United States Of America; Uxbridge, United Kingdom; Lund, Sweden; Beijing, China; Gent, Belgium). Cost-effectiveness of early intervention with budesonide once daily: Results from the START study. Eur Respir J 2002; 20: Suppl. 38, 386

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