Purpose: Compare cost-effectiveness between fluticasone (FP) 88mg twice daily with oral zafirlukast (ZAF) 20mg twice daily in the treatment of asthma.
Methods: Data from two randomized, double-blind, double-dummy, placebo-controlled clinical trials were analyzed. Subjects' previous treatment included low dose inhaled corticosteroids (ICS) (as defined by the NIH guidelines) and short acting beta2-agonists. The primary efficacy parameter was percent improvement in FEV1. Other efficacy measures were symptom-free days (SFD) and improvement in asthma quality of life (QoL). Health care resources (RU) were collected during each asthma exacerbation, defined as additional treatment for asthma symptoms beyond as needed albuterol. Cost of treatment included study drugs, ER visits, unscheduled physician visits, treatment for drug-related adverse events, oral corticosteroids and rescue albuterol. Drug costs were based on AWP and RU costs were based on published data.
Results: The mean asthma treatment cost was $1.66 per day for patients switched to FP and $2.30 for patients switched to ZAF. Patients switched to FP experienced significantly fewer asthma exacerbations (p [is less than] 0.001), better improvement in FEV1 (p [is less than] 0.001) and greater SFD (p [is less than] 0.001). More patients switched to FP experienced improved QoL compared to patients switched to ZAF (p [is less than] 0.001). Cost-effectiveness ratios were lower for patients switched to FP for each 10% improvement in FEV1 ($4.67 vs $9.89), SFD ($3.35 vs $5.71) and 0.5 improvement in AQLQ ($3.18 vs $6.54) and remained lower after sensitivity analysis.
Conclusion: From a third party payer perspective, FP 88mg twice daily is more cost-effective than ZAF 20mg twice daily in patients switched from low-dose ICS.
Clinical Implications: Switching patients from low-dose ICS to low-dose FP is a more cost-effective alternative than switching to oral ZAF.
Supported by: Glaxo Wellcome, Inc.
Richard Stanford, PharmD, MS(*); J Carranza-Rosenweig, PharmD, MS; B Bowers, PharmD; L Edwards, PhD; P Pepsin, BA, RN and K Rickard, MD. Glaxo Wellcome, Inc, Research Triangle Park, NC.
COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group