Cost-effectiveness of formoterol and salbutamol as asthma reliever medication in Sweden and in Spain. Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma. Cost-Effectiveness Analysis of Formoterol Versus Salmeterol in Patients with Asthma An economic evaluation of combination treatment with budesonide and formoterol in patients with mild-to-moderate persistent asthma. Country-specific cost-effectiveness of early intervention with budesonide in mild asthma Determining economic feasibility of fluticasone propionate-salmeterol vs montelukast in the treatment of persistent asthma using a net benefit approach and cost-effectiveness acceptability curves. Cost-effectiveness of fluticasone propionate administered via metered-dose inhaler plus babyhaler spacer in the treatment of asthma in preschool-aged children. Development of an Economic Model to Assess the Cost Effectiveness of Asthma Management Strategies The Episode-Free Day as a Composite Measure of Effectiveness Economic assessment of adjustable maintenance treatment with budesonide/formoterol in a single inhaler versus fixed treatment in asthma Cost Effectiveness of Fluticasone Propionate and Flunisolide in the Treatment of Corticosteroid-Naive Patients with Moderate Asthma Salmeterol/Fluticasone Propionate versus Fluticasone Propionate Plus Montelukast Cost-effectiveness of eformoterol Turbohaler versus salmeterol Accuhaler in children with symptomatic asthma. Cost-effectiveness of early intervention with once-daily budesonide in children with mild persistent asthma: results from the START study. Maintenance plus reliever budesonide/formoterol compared with a higher maintenance dose of budesonide/formoterol plus formoterol as reliever in asthma:an efficacy and cost-effectiveness study Hydrofluoroalkane-134a beclomethasone as a dominant economic asthma therapy. Cost-Effectiveness Comparison of Salmeterol/Fluticasone Propionate versus Montelukast in the Treatment of Adults with Persistent Asthma Cost Effectiveness of Fluticasone and Budesonide in Patients with Moderate Asthma The economic value of anti-IgE in severe persistent, IgE-mediated (allergic) asthma patients:adaptation of INNOVATE to Sweden A Comparison of the Cost Effectiveness of Alternative Prophylactic Therapies in Childhood Asthma Cost Effectiveness of Budesonide/Formoterol for Maintenance and Reliever Therapy versus Salmeterol/ Fluticasone plus Salbutamol in the Treatment of Asthma Ease of handling and clinical efficacy of fluticasone propionate Accuhaler/Diskus inhaler compared with the Turbohaler inhaler in paediatric patients. UK Study Group. Budesonide/formoterol in a single inhaler (Symbicort) reduces healthcare costs compared with separate inhalers in the treatment of asthma over 12 months. Cost Effectiveness of Fluticasone Propionate Plus Salmeterol Versus Fluticasone Propionate Plus Montelukast in the Treatment of Persistent Asthma A cost-effectiveness study comparing the as-needed use of formoterol (Oxis) and terbutaline (Bricanyl) in patients with moderate to severe asthma. Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 microg twice daily and budesonide 800 microg twice daily in the treatment of adults and adolescents with asthma. International Study Group. Is high-dose fluticasone propionate via a metered-dose inhaler and Volumatic as efficacious as nebulized budesonide in adult asthmatics?
This study aim ed to evaluate the cost-effectiveness of formoterol ( Oxis ) Turbuhaler 4.5 microg and salbutamol 200 microg as reliever medications in Sweden and Spain . The study used data on effectiveness ( exacerbations and symptom-free days ) and re source utilisation from an open , 6-month , parallel-group , multicentre r and omised trial with 18,124 asthma patients in 24 countries . Country-specific unit costs for Sweden and for Spain were used to transform re source utilisation data into costs . Total healthcare costs were not significantly different between formoterol and salbutamol dry powder inhalers in Sweden , whereas in Spain , the healthcare costs were 20 % higher for formoterol vs. salbutamol pressurised metered dose inhalers . Total healthcare costs increased with disease severity , defined according to the Global Initiative for Asthma guidelines . Compared with salbutamol , formoterol produced statistically significant improvements in effectiveness , less reliever and maintenance medication usage , reduced healthcare re source utilisation , with no increase or a limited increase in healthcare cost BACKGROUND The Inhaled Steroid as Regular Therapy in Early Asthma ( START ) study reported that early intervention with budesonide in mild persistent asthma reduces severe asthmatic events and improves symptom outcomes and lung function in adults and children . OBJECTIVE We sought to estimate the incremental cost-effectiveness of early intervention with budesonide , as observed within the START study . METHODS START was a r and omized , 3-year controlled trial of budesonide in early onset mild asthma among 7165 subjects ages 5 to 66 years . Three age groups ( 5 - 10 , 11 - 17 , and > or=18 years ) were studied separately and overall . Differences in the probability of emergency treatments , symptom-free days ( SFDs ) , and costs of health care were determined . Incremental cost-effectiveness ratios were estimated from the health care payer and societal perspectives . RESULTS Compared with usual therapy , patients receiving budesonide experienced an average of 14.1 ( SE , 1.3 ) more SFDs per year ( P < .001 ) , fewer hospital days ( 69 % , P < .001 ) , and fewer emergency department visits ( 67 % , P < .05 ) . From the health care payer perspective , the net cost of early use of budesonide was an additional US dollars 0.42 ( SE , dollars 0.04 ) per day , and the result ant cost-effectiveness ratio was US dollars 11.30 ( 95 % CI , US dollars 8.60-US dollars 14.90 ) per SFD gained . From the societal perspective , the cost offsets of lower absence from school or work reduced the net cost of early budesonide to US dollars 0.14 ( SE , US dollars 0.07 ) per day and decreased the cost-effectiveness ratio to US dollars 3.70 ( 95 % CI , US dollars 0.10-US dollars 8.00 ) . Early intervention was more effective and cost saving in the youngest age group . CONCLUSION Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset Abstract Objective : The aim of this study was to determine the relative economic consequences of treating asthmatics with twice daily dry powder formoterol 12 mg as compared with salmeterol 50 mg from a societal perspective . Design and Setting : A r and omised , 6-month , open-label study including 482 patients with asthma was conducted in Italy , Spain , France , Switzerl and , the UK and Sweden .  Medical costs included the costs of medications , physician services , emergency room visits , hospital admissions and lung function and other tests . Travel costs and costs of production loss were also calculated . Unit prices were estimated from external sources . To pool the costs of the 6 countries , European currencies were converted to US dollars using 1995 exchange rates . Outcome measures were the number of episode-free days ( EFDs ) and the number of patients reaching a clinical ly relevant improvement in quality of life as measured using the St. Georges Respiratory Question naire . Main outcome measures and results : There were no significant differences between the 2 treatment arms in the frequency of emergency room visits , hospital admissions , use of rescue medication or contacts with general practitioners ( GPs ) , specialists or nurses . Median medical costs over 6 months were $ US828 per patient with formoterol and $ US850 with salmeterol . This difference was not statistically significant . In both groups , about 60 % of all days were episode-free . Average costs per EFD were about $ US9 for both treatments . The average cost per patient reaching a clinical ly relevant improvement in quality of life was between $ US1300 and $ US1400 . Incremental cost-effectiveness ratios were not calculated because both costs and outcomes were not significantly different . Asthma-related absenteeism ranged between 3 days and 6 months per patient in both groups . Conclusions : There was no evidence to suggest that either treatment was more cost effective than the other Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose , adding a long-acting beta2-agonist , or both . This study assessed the cost-effectiveness of these options . Patients aged > or = 12 years with mild-to-moderate persistent asthma ( n = 1272 ) were r and omised to twice-daily , double-blind treatment with budesonide 100 microg , budesonide 100 microg plus formoterol 4.5 microg , budesonide 200 microg , or budesonide 200 microg plus formoterol 4.5 microg for 12 months . Clinical variables included lung function , number of symptom-free days and number of severe exacerbations . Data on medication use , hospitalisation , visits to health professionals and time off work due to asthma were combined with Swedish unit cost data ( 1999 ) to estimate the mean annual cost per patient . Budesonide 200 microg plus formoterol 4.5 microg had the greatest efficacy and effectiveness .  Budesonide 200 microg plus formoterol 4.5 microg was both more effective and less costly than budesonide 100 microg plus formoterol 4.5 microg , so a cost-effectiveness ratio was not calculated for this comparison . The cost-effectiveness ratio for budesonide 200 microg plus formoterol 4.5 microg compared with budesonide 200 microg alone was SEK 21 per symptom-free days gained . The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost Early intervention with budesonide is an effective strategy for mild persistent asthma , which has been shown to provide additional clinical benefits at a low incremental cost using USA cost data . The present authors analysed whether this strategy would be cost-effective using cost data for other countries . Based on the 3-yr prospect i ve , r and omised , double-blind inhaled Steroid Treatment As Regular Therapy ( START ) in early asthma study ( comparing budesonide and placebo combined with usual asthma therapy ) , the cost-effectiveness was estimated separately for eight different countries , from both healthcare payer and societal perspectives , of adding budesonide to usual asthma therapy .  Local unit costs were applied to data for the total trial population . Incremental cost-effectiveness ratios ( ICER ) were estimated as cost per symptom-free day ( SFD ) gained .  Budesonide  increased SFDs by an average of 14.1 days annually . From a healthcare payer perspective , budesonide would reduce the total cost of asthma care in Australia . In Sweden , Canada , France , Spain , UK , China and the USA , the ICER ranged from US$ 2.4–11.3 per SFD . From a societal perspective , budesonide would be cost-saving in Australia , Canada and Sweden . In conclusion , for countries where costs with budesonide are higher , the policy implication has to be determined by that health system 's willingness to pay for an additional symptom-free day . However , where budesonide therapy increases symptom-free days and reduces total costs , the policy conclusion clearly favours early intervention BACKGROUND The choice of treatment can have a major impact on the total costs associated with asthma care . OBJECTIVE To determine the relative cost-effectiveness of twice-daily treatment with inhaled fluticasone propionate-salmeterol via Diskus , 100/50 microg , with that of once-daily treatment with oral montelukast as initial maintenance therapy in patients with persistent asthma uncontrolled with a short-acting beta2-agonist alone . METHODS Data from a r and omized , double-blind , double-dummy , 12-week clinical trial were analyzed . Efficacy end points included ( 1 ) symptom-free days ( SFDs ) during the 12-week period and ( 2 ) a 12 % or greater increase in forced expiratory volume in 1 second ( FEV1 ) from baseline . The economic analysis was performed from a payer 's perspective , and hence only direct costs were included in the analysis . The incremental cost-effectiveness ratio ( ICER ) , which is the mean difference in average costs divided by the mean difference in average effectiveness , was calculated for both effectiveness outcomes ( SFDs and FEV1 ) . RESULTS For the SFDs end point , the ICER for fluticasone propionate-salmeterol vs montelukast was $ 2.87 ( 95 % confidence interval , -$1.08 to $ 6.65 ) , indicating that it costs , on average , an extra $ 2.87 per day for an additional SFD with fluticasone propionate-salmeterol than with montelukast . With regard to FEV1 , the ICER was $ 1.79 ( 95 % confidence interval , -$0.72 to $ 3.86 ) , indicating that it costs , on average , an extra $ 1.79 per day to achieve a lung function improvement of 12 % or greater from baseline with fluticasone propionate-salmeterol than with montelukast . At a widely acceptable ceiling ratio of $ 9.95 per day , the probability of fluticasone propionate-salmeterol being more cost-effective than montelukast was 99.8 % for SFDs and was almost 100 % for an FEV1 improvement of 12 % of greater . CONCLUSIONS Treating 2 main components of asthma , inflammation and smooth muscle dysfunction , using fluticasone propionate-salmeterol is more cost-effective than using a single mediator antagonist alone , such as montelukast , as initial maintenance therapy for persistent asthma in patients treated with a short-acting beta2-agonist only STUDY OBJECTIVES To evaluate the cost-effectiveness of inhaled fluticasone propionate ( FP ) in children aged 12 to 47 months with asthma symptoms . DESIGN A retrospective economic analysis conducted from the perspective of the Danish health-care system , based on clinical data from a 12-week study . SETTING Thirty-three outpatient centers in nine countries . PATIENTS Two hundred thirty-seven children aged 12 to 47 months with documented history of recurrent wheeze or asthma symptoms . INTERVENTIONS Two dosages of FP , 100 microg/d and 200 microg/d , and placebo administered in two divided doses via a metered-dose inhaler and a Babyhaler ( Glaxo Wellcome ; Middlesex , UK ) spacer device . MEASUREMENTS Effectiveness in terms of asthma exacerbations , control of cough and wheeze symptoms , symptom-free days , overall direct costs of asthma management in Danish kroner at 1999 prices , and mean and incremental cost-effectiveness ratios . RESULTS FP , 200 microg/d , was significantly more effective than placebo treatment in terms of the proportion of exacerbation-free patients ( 73.7 % vs 59.8 % ; p = 0.025 ) and patients experiencing a > or = 25 % improvement in cough symptoms ( 57.9 % vs 39.0 % ; p = 0.018 ) . The costs per exacerbation-free patient , per patient with a > or = 25 % improvement in cough and wheeze symptoms from baseline , and per symptom-free day were lower in the FP groups than in the placebo group . The incremental cost-effectiveness ratios for these end points indicated that the additional benefits of FP , 200 microg/d , were achieved at a lower overall cost compared with placebo treatment . CONCLUSIONS From the perspective of the Danish health-care system , FP , 100 microg bid , administered via the Babyhaler inhalation device was cost-effective relative to st and ard therapy with bronchodilators alone Abstract Background and objective : Asthma is a chronic-episodic disease characterised by acute , symptomatic episodes of varying severity . We developed a Markov model that can be used to estimate the cost effectiveness of alternative asthma treatments . Because of the costs they incur , asthma exacerbations ( ‘ attacks ’ ) requiring intervention by a healthcare professional were a central consideration in the development of the model . Methods : Treatment success was assessed as asthma control , a composite measure based on goals defined in world-wide asthma management guidelines and in terms of quality -adjusted life-years ( QALYs ) . The data from which the transition probabilities were derived came from patients with asthma who received either salmeterol/fluticasone propionate combination ( SFC ) 50/100μg or fluticasone propionate ( FP ) 100μg , administered twice daily via an inhaler , in a 12-week , r and omised , double-blind , clinical trial . Costs were estimated from re source profiles defined for each of the model states . A key aspect of the model was the use of probabilistic sensitivity analysis techniques to examine the uncertainty in the cost-effectiveness results . Distributions were fitted to transition probabilities and to cost input parameters and values were sample d at r and om from these distributions using a second order Monte Carlo simulation technique . This produced a distribution for incremental cost effectiveness that was employed to construct 95 % uncertainty intervals and to construct cost effectiveness acceptability curves . Results : In this analysis , the model was run over a 12-week period using transition probabilities derived from the trial data . The results showed that treatment with SFC result ed in a higher proportion of successfully controlled weeks per patient than treatment with FP(66 vs 47 % ) , and higher mean weekly direct asthma management costs ( £ 15.77 vs £ 11.83 ; 2000 values ) . The average incremental cost per successfully controlled week with SFC was £ 20.83.Probabilistic sensitivity analysis showed that the 95 % uncertainty intervals for the incremental cost-effectiveness ratio was −£64.94 to £ 112.66 . In approximately 25 % of cases , SFC was dominant ( more effective and less costly ) , but in the remaining cases , it was both more effective and more costly . It was shown that if decision makers are willing to pay approximately £ 45 for an additional successfully controlled week , SFC will be the more cost-effective strategy in this patient population for 80 % of the time . Conclusions : This is one of the first decision-analytic models of asthma to incorporate probabilistic sensitivity analysis techniques to explore uncertainty . The model ’s flexible yet st and ardised framework permits the cost effectiveness of alternative asthma management strategies in different healthcare setting s to be established Summary The construction of a composite effectiveness measure was explored using clinical data collected routinely in trials of drug therapies for asthma . The measure is the episode-free day ( EFD ) , where an ‘ episode ’ is either an asthma attack , the need for rescue medication , sleep disturbance caused by asthma , or an adverse event . The EFD measure was used in a retrospective cost-effectiveness analysis of a previous Phase III controlled clinical trial of formoterol versus salbutamol , in which 145 patients with bronchial asthma were r and omised to receive maintenance therapy with either inhaled formoterol or inhaled salbutamol over a 12-week period . Average and incremental cost-effectiveness ratios were assessed for the 2 drugs in terms of the total expected cost of drug plus rescue therapy , and EFD rates . The analysis suggests that , with relatively little addition to clinical data collection , economically and clinical ly meaningful composite measures can be constructed to assist in making cost-effectiveness comparisons between alternative asthma therapies Abstract Objectives : To compare the costs and effectiveness of adjustable maintenance dosing with budesonide/formoterol in a single inhaler versus fixed dosing in adults with asthma . Methods : In this prospect i ve , r and omised , open-label , parallel-group , multicentre trial conducted in Germany , patients with asthma received budesonide/formoterol 160µg/4.5 µg in a single inhaler ( Symbicort ® Turbuhaler ® ) with two inhalations twice daily for a 4-week run-in period . Patients were then r and omised to either adjustable maintenance dosing ( one inhalation twice daily , stepping up to four inhalations twice daily for 1 week if asthma worsened ; n = 1679 ) or fixed dosing ( two inhalations twice daily ; n = 1618 ) for 12 weeks . The primary efficacy variable was the change in health-related quality of life ( HR-QOL ) , measured using the Asthma Quality of Life Question naire ( st and ardised ) during the r and omised treatment period . Re source utilisation data were collected in parallel and combined with German unit costs to estimate direct and indirect costs ( year 2001 values ) . Results : Both treatment regimens were equally effective in maintaining HR-QOL and asthma control during the r and omised treatment period . However , overall , patients in the adjustable maintenance dosing group took fewer daily inhalations of budesonide/formoterol  than those in the fixed-dosing group ( mean : 2.63 vs 3.82 inhalations ; p < 0.001 ) . Adjustable maintenance dosing was associated with significantly lower asthma-related direct costs  compared with fixed dosing ( mean : € 221 vs € 292 ; p < 0.001 ) . This pattern was maintained when patients were stratified into those with peak expiratory flow ( PEF ) of 60 % to < 80 % predicted normal and those with PEF of ≥80 % predicted normal and when total costs were considered . Conclusion : Adjustable maintenance dosing with budesonide/formoterol in a single inhaler maintained HR-QOL in adult patients with asthma at a significantly lower cost than fixed dosing Abstract Objective : The aim of this study was to determine the cost effectiveness of 2 inhaled corticosteroids , fluticasone propionate and flunisolide , in the management of asthma from a third-party payer perspective in Germany ( German Sickness Fund ) . Design and setting : Direct treatment costs were retrospectively applied to 2 prospect i ve r and omised parallel group clinical trials conducted in Germany comparing fluticasone propionate and flunisolide : one 6-week open-label study ( n = 332 ) and one 8-week double-blind study ( n = 308 ) in corticosteroid-naive patients with asthma of moderate severity aged between 18 and 70 years . All costs were adjusted to 1997 Deutschmarks . Efficacy parameters included changes in morning and evening peak expiratory flow rate ( PEFR ) measurements , the number of successfully treated patients ( defined as those with a PEFR improvement of ≥10 % ) and proportion of symptom-free days . Main outcome measures and results : The fluticasone propionate groups had higher respective proportions of successfully treated patients and symptom-free days than the flunisolide groups in both the open-label ( 56.8 vs 39.6 % and 36.4 vs 28.5 % ) and double-blind ( 55.3 vs 44.5 % and 35.1 vs 31.1 % ) studies . Improvements in both morning and evening PEFR measurements were also significantly ( p < 0.01 ) greater with fluticasone propionate than with flunisolide . Although average daily treatment costs were slightly higher in the fluticasone propionate groups than in the flunisolide groups , all cost-effectiveness ratios ( daily cost per successfully treated patient and daily cost per symptom-free day ) favoured fluticasone propionate . Sensitivity analysis showed that these results were robust over a wide range of assumptions . Conclusion : In these patients , management with fluticasone propionate was more cost effective than with flunisolide in the German healthcare setting Introduction and objective Asthma , owing to its chronic nature , is associated with a substantial economic burden . Healthcare providers need to compare the cost effectiveness of alternative asthma treatment options to ensure that they obtain the best value for money from the re sources they control . The objective of the current study was to compare the cost effectiveness of salmeterol/fluticasone propionate in combination with fluticasone propionate plus montelukast in patients with symptomatic asthma uncontrolled with inhaled corticosteroid ( ICS ) monotherapy . Study design and methods Direct healthcare re source data were prospect ively collected during a double-blind , r and omized , 12-week clinical study of inhaled salmeterol/fluticasone propionate 50/100 µg twice daily ( n = 356 ) and inhaled fluticasone propionate 100 µg twice daily plus oral montelukast 10 mg daily ( n = 369 ) . Re sources were costed in Dutch guilders ( NLG ) from the perspective of The Netherl and s healthcare system using 1999/2000 prices , but have been presented in US dollars and euros . The primary effectiveness measure was the proportion of successfully treated weeks ( based on mean morning PEF values ) . Secondary measures were episode-free days , symptom-free days , and symptom-free nights . Results Salmeterol/fluticasone propionate was more effective than fluticasone propionate plus montelukast as measured by the proportion of successfully treated weeks mean 63.3 % vs 39.0 % ; median difference 25 % ; p < 0.001 ) . Salmeterol/fluticasone propionate was also more effective than fluticasone propionate plus montelukast according to the secondary effectiveness measures . The mean total direct daily healthcare costs per patient were 16 % higher with fluticasone propionate plus montelukast than with salmeterol/fluticasone propionate mainly due to higher drug costs in the former group ( $ US2.25 vs 1.94 ; € 1.92 vs 1.66 , respectively ; the NLG was fixed against the euro at a rate of € 1 = NLG2.2 on 31 December 1998 ; $ US1 = NLG1.883 , June 2003 ; $ US1 = € 0.848 , June 2003 ) . Incremental cost-effectiveness analyses showed that salmeterol/fluticasone propionate was dominant over fluticasone propionate plus montelukast and sensitivity analyses showed these results to be robust . ConclusionS almeterol/fluticasone propionate is a more cost-effective treatment option than fluticasone propionate plus montelukast for patients with symptomatic asthma uncontrolled by ICS We conducted an economic evaluation in a UK setting based on a 12-week prospect i ve r and omized open-label parallel-group comparison of eformoterol Turbohaler 12 microg b. i.d . with salmeterol Accuhaler 50 microg b. i.d . in children aged 6 - 17 with symptomatic asthma receiving inhaled corticosteroids and short-acting beta2-agonists .  The principal effectiveness measure was percentage of symptom-free days with no short-acting beta2-agonist use during the study period . Asthma-related medication , unscheduled physician contacts and hospitalizations were collected prospect ively and cost to the UK NHS calculated using year 2,000 prices . The economic evaluation included 73 patients in the eformoterol group and 72 patients in the salmeterol group . The mean age of patients was 11.6 years ( eformoterol ) and 11.8 years ( salmeterol ) . The mean percentage of symptom-free days with no short-acting beta2-agonist use was 39 % in the eformoterol group and 30 % in the salmeterol group . Mean per patient daily cost was 1.15 pounds in the eformoterol group and 1.39 pounds in the salmeterol group . Both cost and effectiveness differences favoured eformoterol ( P < 0.05 ; one-sided ) . Sensitivity analysis confirmed the results to be robust to changes in effectiveness , price and re source utilisation parameters . Eformoterol delivered by Turbohaler was found to be significantly more effective and less expensive than salmeterol Accuhaler in this study The inhaled Steroid Treatment As Regular Therapy in early asthma ( START ) study has shown that early intervention with inhaled budesonide in mild persistent asthma improves clinical outcomes in both adults and children . The aim of this study was to estimate the incremental cost-effectiveness of early treatment with budesonide Turbuhaler in children aged 5 - 10 yr who participated in START .  Direct and indirect costs associated with asthma were determined for 1974 children participating in the double-blind , 3-year part of the study . R and omization was to placebo or to budesonide 200 microg once daily in each case in addition to usual asthma care . Cost-effectiveness ratios were calculated from the healthcare payer 's and societal perspectives ( using US prices ) . The addition of once-daily budesonide therapy to usual asthma care was associated with 16 additional symptom-free days ( SFDs ) per child over the 3-yr period ( p < 0.001 ) , with a substantial reduction ( 50 % ) in the mean number of days spent in hospital , and with reduced frequency of emergency room visits and missed school and caregiver work days . From the healthcare payer 's perspective ( direct costs ) , the increase in mean direct cost over 3 yr with budesonide was 169 dollars , which translated into an incremental cost of early intervention with budesonide in children of 10.50 dollars ( 95 % CI 1.20 - 33.30 dollars ) per SFD gained . From the societal perspective , there was a cost reduction over 3 yr of 192 dollars with budesonide relative to placebo . From a societal perspective , budesonide was therefore dominant . In conclusion , early intervention with once-daily budesonide added to usual asthma care in children with mild persistent asthma is cost-saving from a societal perspective and is acceptably cost-effective when viewed from a healthcare payer perspective ABSTRACT Objective : To evaluate efficacy and costeffectiveness of budesonide/formoterol ( Symbicort * ) maintenance ( one dose once or twice daily ) plus additional doses as needed ( Symbicort Maintenance And Reliever Therapy , SMART ) compared with a higher fixed dose of budesonide/ formoterol with formoterol as needed in patients with persistent asthma .  * Symbicort is a registered trade name of the AstraZeneca group of companies Study design and methods : 6‐month , open , r and omised study of 465 patients either not well controlled on an inhaled corticosteroid ( ICS ) , or well controlled on a combination of ICS and a long-acting β2‐agonist ( LABA ) . Treatments : budesonide/formoterol 160/4.5 µg , one inhalation , once or twice daily maintenance plus additional doses as-needed ( 1 × SMART or 2 × SMART ) , or budesonide/formoterol 160/4.5 µg two inhalations twice daily plus formoterol 4.5 µg as needed ( 2 × 2 FIX + F ) . Children 6–11 years old used an 80/4.5 µg dose strength . Primary variables of efficacy were the changes in the Asthma Control Question naire ( ACQ5 ) and morning peak expiratory flow ( PEF ) . Results : Mean age of patients 40 years ( range 6–82 years ) ; 53 % female . No differences between the groups were found in ACQ5 scores or asthma exacerbation rates . Morning PEF was higher in the 2 × 2 FIX + F group vs. the 1 × SMART and 2 × SMART groups ( differences 13 L/min and 9 L/min , respectively ; p < 0.002 ) . The 1 × SMART group showed a significant decrease in asthma controlled days compared with the two other groups . No difference was seen between the 2 × SMART group and the 2 × 2 FIX + F group . Treatment costs were significantly lower in the SMART groups compared with the 2 × 2 FIX + F group . Conclusion : Compared with the 2 × 2 FIX + F treatment the use of budesonide/formoterol was 30–40 % lower in the SMART groups while maintaining equal ACQ5 scores . Daily asthma control improved equally with 2 × SMART compared to 2 × 2 FIX + F with a reduction in asthma medication cost . The one dose once daily maintenance treatment ( 1 × SMART ) result ed in a low level of treatment failure ( exacerbations ) but led to more days with symptoms . Therefore , a daily dose of two inhalations seems to be the lowest appropriate dose in patients with moderate persistent asthma Inhaled corticosteroids for asthma treatment have become mainstay of therapy for patients with persistent asthma . Numerous inhaled corticosteroids are available but to date no prospect i ve cost-effectiveness studies have been reported using exclusively US patients and costs . The purpose of this study was to examine the cost-effectiveness of HFA-bectomethasone ( QVAR ) compared to CFC-beclomethasone ( Vanceril ) using data from a year-long prospect i ve r and omized , open label , parallel multicenter trial . Eligibility criteria required patients to have been on a stable dose of CFC-BDP prior to enrollment . Patients were r and omized to either HFA-BDP at approximately half their previous daily dose of CFC-BDP or to continue CFC-BDP Effectiveness data , in terms of symptom-free days ( SFDs ) , were used in a cost-effectiveness analysis conducted from the viewpoint of managed care . Patients receiving HFA-BDP reported a greater increase ( median = 22.1 ) in the number of SFDs than those receiving CFC-BDP ( median = 14.3 ) ( P = 0.03 ) . Total costs of care were less for patients taking HFA-BDP ( median = dollars 668 ) compared to CFC-BDP ( median = dollars 977 ) . The median incremental cost-effectiveness ratio was dollars -5.77 ( 95 % CI : dollars -68.08 to dollars -4.08 ) . The results of this analysis indicate that HFA-BDP was a dominant therapy ( more effective , less costly ) compared to CFC-BDP Abstract Objective : To compare the relative cost effectiveness of salmeterol (50μg)/ fluticasone propionate ( 100μg ) with that of oral montelukast ( 10 mg ) as initial maintenance therapy in patients with persistent asthma uncontrolled on short-acting β2-agonist therapy alone . Study design : A cost-effectiveness analysis was performed based on effectiveness and re source utilisation data that was prospect ively collected from a r and omised , double-blind , double-dummy , 12-week trial . Patients and methods : Patients ( > 15 years of age ) who had asthma for at least 6 months . Effectiveness measurements in this analysis included improvement in forced expiratory volume in 1 second ( FEV1 ) and symptom-free days ( SFDs ) . Cost of asthma drug treatment as well as costs related to an asthma exacerbation were used in the cost analysis . The study assumed a payer ’s perspective . All costs are in 2001 US dollars . Results : Of the 423 patients eligible for the study , 211 were r and omised to salmeterol/fluticasone propionate and 212 to montelukast . Treatment with salmeterol/fluticasone propionate result ed in a significantly higher proportion of patients who achieved a 12 % increase in FEV1 ( successful treatment ) [ salmeterol/fluticasone propionate : 71 % vs montelukast : 39 % ; p < 0.001 ] and percentage of SFDs  ( salmeterol/fluticasone propionate : 46.8 % vs montelukast : 21.5 % ; p < 0.001 ) compared with montelukast . The mean daily costs per successfully treated patient were lower in the salmeterol/fluticasone propionate group ( $ US5.03 , 95 % CI $ US4.61 to $ US5.50 ) compared with the montelukast group ( $ US8.25 , 95 % CI $ US6.98 to $ US9.93 ) . Furthermore , per patient mean daily cost per SFD was lower with salmeterol/fluticasone propionate ( $ US7.63 , 95 % CI $ US6.90 to $ US8.50 ) compared with montelukast ( $ US14.89 , 95 % CI $ US12.36 to $ US17.98 ) . Incremental cost-effectiveness ratios ( ICERs ) showed that the additional costs to achieve these benefits with salmeterol/fluticasone propionate were minimal . With regards to improvement in lung function , the ICER was $ US1.33 ( 95 % CI $ US0.80 to $ US2.02 ) and with regards to SFD , the ICER was $ US1.69 ( 95 % CI $ US1.01 to $ US2.48 ) . Sensitivity analysis demonstrated the stability of the results over a range of assumptions . Conclusions : From a third-party payer perspective , this analysis shows that based on increased efficacy and only a slight increase in cost , twice-daily treatment with salmeterol/fluticasone propionate is more cost effective than once-daily treatment with montelukast as initial maintenance therapy for persistent asthma . This finding complements the results of the clinical analyses indicating that treatment of both inflammation and bronchoconstriction with products such as salmeterol/fluticasone propionate may be more cost effective as initial maintenance asthma therapy than the use of leukotriene modifiers such as montelukast Abstract Objective : The objective of this study was to assess the relative cost effectiveness of fluticasone via metered dose inhaler and budesonide via Turbuhaler ® in corticosteroid-naive patients with moderate asthma from a third-party payer perspective ( German Sickness Funds ) . Patients and Methods : A retrospective economic assessment of direct medication costs of treatment was performed on data from a prospect i ve , r and omised , parallel group , 6-week clinical trial . 457 corticosteroid-naive patients between the ages of 18 and 70 years with moderate asthma were included in the intention-to-treat analysis . Results : The fluticasone group had a higher proportion of successfully treated patients ( those with a peak expiratory flow rate improvement of ≥10 % ) [ 47 vs 42 % ] , a higher average proportion of symptom-free days ( 40 vs 34 % ) and lower direct healthcare costs [ 1997 Deutschmarks ( DM ) ] per day ( DM4.23 vs DM5.19 ) than the budesonide group . Therefore , the daily costs per successfully treated patient ( DM9.00 vs DM12.36 ) and the cost per symptom-free day ( DM10.58 vs DM15.26 ) were both lower with fluticasone than with budesonide . Sensitivity analysis demonstrated that these results were relatively robust over a wide range of plausible assumptions . Conclusion : These results showed that from the perspective of a third-party payer , fluticasone was more cost effective  than budesonide over the 6-week study period ABSTRACT Background : Severe allergic asthma patients may not be controlled even with guideline recommended care , including inhaled corticosteroids , long-acting beta-2 agonists , theophylline , oral steroids and anti-leukotrienes . They experience exacerbations requiring intensive healthcare use and which may be fatal . Omalizumab , a new monoclonal antibody for use in IgE-mediated allergic diseases , reduces exacerbations and daily symptoms in this patient population . The aim of this study is to estimate the cost effectiveness of adding omalizumab to optimized st and ard therapy ( ST ) in patients with severe persistent IgE-mediated ( allergic ) asthma . Methods : A Markov model comparing lifelong ST with a treatment period of omalizumab add-on therapy followed by ST , was developed based on efficacy data from the INNOVATE trial ( 28 weeks , N = 419 ) and Swedish life table and cost data . This model assumes that patients are at risk of having an exacerbation every 2 weeks and are at risk of dying from a clinical ly significant severe asthma exacerbation . Patients in a steady-state of having no exacerbations are defined to be in an ‘ optimized asthma control ’ state . Re source use data and utilities were obtained from INNOVATE and from a UK observational study . Costs from a societal perspective include estimates for drugs , routine care , exacerbations and costs in added years of life ; benefits are expressed in QALYs . The response to omalizumab was evaluated after 16 weeks of trial , and non-responders stopped taking omalizumab for the remaining time . Results : Total lifetime discounted costs and QALYs on ST were € 52 702 and 11.60 . Omalizumab add-on therapy cost an additional € 42 754 for 0.76 additional QALYs , result ing in an incremental cost-effectiveness ratio of € 56 091 . A probabilistic sensitivity analysis indicates that the 95 % CI around the ICER is [ € 31 328 ; € 120 552 ] . One-way analyses indicate that the results are sensitive to the exacerbation-related mortality rate , the time horizon and the discount rates . Conclusions : Based on the model and the assumptions used , our results suggest that omalizumab provides cost offsets , improves quality of life and may have an attractive ICER in treating the severe allergic asthma population Summary An economic analysis was conducted comparing the cost effectiveness of fluticasone propionate with that of sodium cromoglycate ( cromolyn sodium ) in a group of children aged 4 to 12 years old with asthma , who required inhaled prophylactic therapy . Over an 8-week study period , 115 patients received sodium cromoglycate 20 mg 4 times daily , via the spin operated dry powder inhaler , and 110 patients received fluticasone propionate 50llg twice daily , via the Diskhaler ™ (trademark held by the Glaxo Wellcome Group of Companies ) . Patient healthcare re source use was examined in terms of study medication , the use of rescue medication [ salbutamol ( albuterol ) 200 µg ] and the number of hospitalisations . The effectiveness of both treatments was examined over a range of success and failure criteria embracing peak expiratory flow rate ( PEFR ) improvement , symptom control and the level of adverse events related to the study medication . Results indicate that , for each UK pound ( £ ) spent , fluticasone propionate was associated with twice as many successfully treated patients as sodium cromoglycate , using a range of outcomes based on the goals of treatment defined in the British Thoracic Society ’s asthma guidelines .It is concluded that fluticasone propionate was more cost effective than sodium cromoglycate  in improving PEFR and symptom control in this group of children with asthma who had a clinical requirement for prophylactic therapy Abstract Introduction : Budesonide/formoterol ( Symbicort ® ) Maintenance And Reliever Therapy ( SMART ) is an effective and well tolerated treatment option for patients with asthma . We compared the cost effectiveness from a societal perspective of this one-inhaler regimen with that of maintenance salmeterol/fluticasone propionate ( Seretide ® ) plus salbutamol ( albuterol ) as needed ( Seretide ® Fixed Combination [ SFC ] ) . Study design : A cost-effectiveness analysis was performed based on effectiveness and re source -utilisation data collected prospect ively in a r and omised , 12-month study performed in 2143 patients in 16 countries . Re source utilisation data were pooled and unit costs ( € , year 2003 values ) from Italy , France , the UK and Germany were used to generate estimates of direct and total costs per patient per year and cost per severe exacerbation avoided . Methods : Adolescents and adults with asthma ( n = 2143 ; mean forced expiratory volume in 1 second [ FEV1 ] 73 % predicted ; mean inhaled corticosteroid [ ICS ] dose 884 µg/day ) were r and omised to SMART or SFC . The effectiveness measure used was the number of severe exacerbations per patient per year . Direct costs included medication use ( budesonide/formoterol 160µg/4.5 µg or salmeterol/fluticasone 50µg/100 µg , 50µg/250 µg or 50µg/500 µg plus salbutamol ) and nonmedication-related re source use , including days in hospital , emergency room visits , specialist or primary care physician visits and other healthcare provider contacts . Indirect costs , including the number of days when the patient or their carer was unable to attend to their normal daily activities , were also assessed . The study assumed a European societal perspective ( i.e. including direct and indirect costs ) . Results : Treatment with SMART result ed in significantly fewer severe exacerbations per patient per year compared with SFC ( 0.24 vs 0.31 events per patient per year ; p = 0.0025 ) . Re source use was low in both groups . Medication costs accounted for the majority of the total costs . The increased  effectiveness of SMART was achieved at a reduced or similar cost compared with SFC . SMART dominated when German unit costs were applied ( i.e. there was a statistically significant reduction in both costs and number of exacerbations ) . In all other countries , the incremental cost-effectiveness ratios showed that there was a reduction in mean total cost per exacerbation avoided ; however , this difference was not statistically significant . Conclusion : This analysis demonstrates that , compared with SFC , SMART may be cost effective from a societal perspective for the treatment of patients with asthma in Italy , Germany , France and the UK . SMART provided a reduction in the number of severe exacerbations per patient per year , at no statistically significant increase in cost — or even at a lower cost — compared with SFC plus as-needed reliever salbutamol A total of 323 children aged 4 - 11 years who were receiving , or had symptoms indicating a clinical requirement for , inhaled corticosteroid at a daily dose of 400 micrograms budesonide ( BUD ) or beclomethasone dipropionate ( BDP ) , or 200 micrograms fluticasone propionate ( FP ) , were r and omised into this multicentre , open-label , parallel group study . Patients received either FP 100 micrograms b.d . administered via the Accuhaler/Diskus inhaler ( n = 159 ) or BUD 200 micrograms b.d . administered via a Turbohaler inhaler ( n = 164 ) for four weeks and recorded daily their morning and evening peak expiratory flow ( PEF ) , asthma symptoms and use of relief medication . Device h and ling was assessed by a question naire , with responses recorded on three- or five-point ordinal scales . The primary efficacy parameter was mean percent predicted morning PEF . The device h and ling results showed the Accuhaler/Diskus inhaler was rated more favourably than the Turbohaler inhaler in terms of ease of correct inhaler use , ease of telling how many doses were left , ease of knowing whether a dose had been inhaled and overall liking of the device . More patients in the Accuhaler/Diskus group ( 85 % ) than in the Turbohaler group ( 58 % ) said they would be happy to receive the same device again , while 8 % and 25 % respectively said they would not be happy to be given it again . In addition , the change from baseline to week 4 of treatment in mean percent predicted morning PEF was greater in the FP Accuhaler/Diskus group , indicating that FP 200 micrograms daily via Accuhaler/Diskus inhaler is at least as clinical ly effective as BUD 400 micrograms daily via the Turbohaler inhaler This open , multinational , r and omised , parallel-group , six-month extension conducted in the Swedish centres of a previous six-month study compared the costs of a total of 12 months of treatment with budesonide/formoterol in a single inhaler with budesonide plus formoterol separate inhalers in 320 adults with asthma . Patients received budesonide/formoterol ( Symbicort Turbuhaler ) 160/4.5 mg delivered doses , two inhalations b.i.d . , or corresponding doses of budesonide ( Pulmicort Turbuhaler ) plus formoterol ( Oxis Turbuhaler ) . Direct costs and indirect costs were estimated . Budesonide/formoterol treatment was associated with reduced healthcare service utilisation and statistically significant reductions in direct ( SEK1595 , p=0.0004 ) and total costs ( SEK1884 , p=0.043 ) per person per year compared with budesonide plus formoterol . Budesonide/formoterol reduced the average annual emergency room admission cost per person by SEK489.7 ( 31 % of direct cost reduction ) and physician costs by SEK235.4 (15%).The direct cost of study , relief and other medication was reduced by SEK893.8 ( 47 % of total reduction ) . There were no statistically significant differences in efficacy and safety parameters following treatment with budesonide/formoterol from single or separate inhalers , other than a significantly lower proportion of withdrawals with the single inhaler ( 9.2 % vs 19.4 % , p=0.008 ) . In summary , budesonide/formoterol treatment from a single inhaler reduced 12-month treatment costs compared with separate inhalers , while maintaining at least as good control of asthma Abstract Background : Asthma is a chronic disease , the two main components of which are inflammation and bronchoconstriction . Fluticasone propionate ( FP ) and salmeterol , a strategy that treats both main components of asthma , has been recently compared with FP plus montelukast in a r and omised clinical trial . The present study reports economic evaluation of these two strategies . Objective : To determine the relative cost effectiveness when persistent asthma is treated with FP/salmeterol 100/50μg twice daily administered via a single Diskus ® inhaler device versus treatment with FP 100μg twice daily via a Diskus ® inhaler plus oral montelukast 10 mg once daily . Study design : A cost-effectiveness analysis was performed by applying cost unit data to re source utilisation data collected prospect ively during a US r and omised , double-blind , 12-week trial of  FP/salmeterol ( n = 222 ) versus FP + montelukast ( n = 225 ) . Patients were ≥15 years of age and were symptomatic despite inhaled corticosteroid ( ICS ) therapy . Patients and methods : Efficacy measurements in this analysis included improvement in forced expiratory volume in 1 second ( FEV1 ) and symptom-free days . Direct costs included those related to study drugs , emergency room department visits , unscheduled physician visits , treatment of drug-related adverse events ( oral c and idiasis ) , and rescue medication ( salbutamol [ albuterol ] ) . The study assumed a US third-party payer ’s perspective with costs in 2001 US dollars . Results : Treatment with FP/salmeterol result ed in a significantly higher proportion ( p < 0.001 ) of patients who achieved a ≥12 % increase in FEV1 than treatment with FP + montelukast ( 54 % [ 95 % CI 47 % , 61 % ] vs 32 % [ 95 % CI 26 % , 38 % ] ) . Lower daily costs and greater efficacy of FP/salmeterol result ed in a cost-effectiveness ratio of $ US6.77 ( 95 % CI $ US5.99 , $ US7.66 ) per successfully treated patient in the FP/salmeterol group compared with $ US14.59 ( 95 % CI $ US12.12 , $ 17.77 ) for FP + montelukast . In addition , FP/salmeterol achieved similar efficacy in terms of symptom-free days compared with FP + montelukast ( 31 % [ 95 % CI 26 % , 35 % ] vs 27 % [ 95 % CI 23 % , 32 % ] ) , but at a significantly lower daily per-patient cost ( $ US3.64 [ 95 % CI $ US3.60 , $ US3.68 ] vs $ US4.64 [ 95 % CI $ US4.56 , $ US4.73 ] ) . Sensitivity analyses demonstrated the stability of the results over a range of assumptions . Conclusion : From a US third-party payer ’s perspective , these findings suggest that treating the two main components of asthma ( inflammation and bronchoconstriction ) with FP/salmeterol may not only be a more cost-effective strategy but may actually lead to cost savings compared with the addition of montelukast to low-dose FP in patients with persistent asthma . The results were found to be robust over a range of assumptions This study evaluated the economic and health-related consequences of the as-needed use of a long-acting beta2-agonist with fast onset ( formoterol , Oxis Turbuhaler 4.5 microg ) versus a short-acting beta2-agonist ( terbutaline , Bricanyl Turbuhaler 0.5 mg ) in patients with moderate to severe asthma . A multi-national ( Sweden , Norway , The Netherl and s and Greece ) , multi-centre ( 35 centres ) , r and omized , double-blind clinical trial was conducted using 362 patients on inhaled steroids during a 12-week period . The effectiveness results were pooled and the total costs included estimates for beta2-agonists , inhaled steroids , oral steroids , physician visits and sick-leave . The 182 patients in the formoterol group had 14,404 days of exposure and 29 severe exacerbations , and the 180 patients in the terbutaline group had 13,655 days of exposure and 48 severe exacerbations . The terbutaline group had 62 % more severe exacerbations than the formoterol group ( P=0.039 ) , based on exposure time . Per patient , the calculated total costs were SEK 3386 for the formoterol group and SEK 3709 for the terbutaline group over the 12-week period . The conclusion is that the use of Oxis Turbuhaler instead of Bricanyl Turbuhaler for as-needed treatment is a more effective treatment generating cost savings from a societal perspective Despite a good underst and ing of the disease and its treatments , asthma continues to place a large economic burden on healthcare systems . As such , it is important to consider the economic impact of alternative therapeutic options for the treatment of this condition to ensure that scarce re sources are used in the most efficient manner possible . Thus , the aim of asthma management from an economic perspective is to reduce the burden of this disease through maximizing health gain with available re sources . A prospect i ve economic analysis was conducted as part of a multicentre , r and omized , double-blind , comparative trial of salmeterol/fluticasone propionate combination product ( SFC ) 50/250 microg twice daily vs. budesonide ( 800 microg twice daily ) in adults and adolescents with asthma who were symptomatic despite treatment with inhaled corticosteroids at doses of 800 - 1200 microg day(-1 ) .  Treatment effectiveness was measured in terms of successfully-treated weeks , defined as a > or = 5 % improvement in morning peak expiratory flow , episode-free days ( a day without the need for rescue medication , no nocturnal awakening or adverse events ) and symptom-free days . Cost-effectiveness analyses were performed using direct healthcare and drug costs , from the perspective of the Swedish healthcare system ( 1998 prices ) , with appropriate sensitivity analyses to test the robustness of the findings . Overall , SFC produced significantly higher ( P<0.001 ) proportions of successfully-treated weeks , episode-free days and symptom-free days . Direct asthma management costs were similar between the two groups [ SEK19.6 ( $ US2.4 ) for SFC vs. SEK18.5 ( SUS2.2 ) for budesonide ] . The cost per successfully-treated week was lower for SFC than for budesonide [ SEK204 ( $ US24.8 ) vs. SEK300 ( $ US36.4 ) per week ] , as were the costs per episode-free day [ SEK51.1 ( $ US6.2 ) vs. SEK75.1 ( $ US9.1 ) per day ] and symptom-free day [ SEK42.2 ( $ US5.1 ) vs. SEK53.0 ( $ US6.4 ) per day ] . Incremental cost-effectiveness ratios showed that the additional costs to achieve additional benefits with SFC were minimal . Costs per additional successfully-treated week , symptom-free day and episode-free day with SFC were SEK31.6 ( $ US3.9 ) , SEK9.2 ( $ US1.1 ) and SEK7.7 ( $ US0.9 ) , respectively , relative to budesonide . Sensitivity analysis showed that the results were stable over a wide range of assumptions . The results suggest that SFC is a more cost-effective treatment than budesonide  in the management of moderate to severe asthma The efficacy and tolerability of fluticasone propionate ( FP ) 2 mg daily via a metered-dose inhaler and Volumatic ( Glaxo Wellcome ) spacer device was compared with nebulized budesonide ( nBUD ) , 2 and 4 mg daily , in a multi-centre , open-label , cross-over study of adult asthmatics . Patients received , in r and om order , either 4 weeks of treatment with FP followed by 4 weeks of treatment with nBUD , or vice versa , with an intervening 4 week ' wash-out ' period between treatments . Thirty patients completed the study , of whom 24 were evaluable . In terms of the primary efficacy parameter , change in mean morning peak expiratory flow ( PEF ) ( l min-1 ) from baseline to the fourth week of each treatment period , FP was more effective than nBUD [ mean difference ( FP-nBUD ) 21.1 l min-1 , P = 0.007 , 95 % CI ( 6.5 , 35.7 ) ] . Sub-group analysis demonstrated FP to be superior to the 4 mg nBUD [ mean treatment difference ( FP-nBUD ) 42.9 l min-1 , P = 0.026 , 95 % CI ( 7.1 , 78.8 ) ] and at least as efficacious as the 2 mg nBUD sub-group [ mean treatment difference ( FP-nBUD ) 10.2 l min-1 , P = 0.211 , 95 % CI ( -6.5 , 26.9 ) ] . Furthermore , larger reductions in diurnal variation were observed during FP treatment [ mean treatment difference ( FP-nBUD ) -4.4 percentage points , P = 0.028 , 95 % CI ( -8.4 , -0.5 ) ] . There was no significant difference between the treatments for the proportion of symptom-free 24 h periods . Of those expressing a preference , significantly more patients found FP via a metered-dose inhaler and spacer device both easier to administer ( 78 % , P = 0.007 ) and more convenient to take ( 76 % , P = 0.008 ) than nebulized budesonide . In addition , cost per patient analysis showed that nebulized budesonide was from 1.7 to 3.5 times more expensive than FP
BACKGROUND Asthma 's cost-effectiveness is a major consideration in the evaluation of its treatment options .
Our objective was to perform a systematic review of the cost-effectiveness of asthma medications .