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Respir Med. 2017 Aug;129:199-206. doi: 10.1016/j.rmed.2017.06.016. Epub 2017 Jun 24.

Initiating or changing to a fixed-dose combination of Fluticasone propionate/Formoterol over Fluticasone propionate/Salmeterol: A real-life effectiveness and cost impact evaluation.

Author information

1
Observational and Pragmatic Research Institute, Singapore.
2
Academic Primary Care, University of Aberdeen, Aberdeen, UK.
3
Peterhead Health Centre, Aberdeen, UK.
4
Primary Research Ltd, Norwich, UK.
5
McMullans Pharmacy, Belfast, UK.
6
University of Bath, Bath, UK.
7
Elmham Surgery, Norfolk, UK.
8
Instituto de Investigación Hospital Universitario de la Princesa (IISP) Universidad Autónoma de Madrid, Madrid, Spain.
9
Optimum Patient Care, Cambridge, UK.
10
Observational and Pragmatic Research Institute, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK. Electronic address: dprice@opri.sg.

Abstract

OBJECTIVE:

Asthma has a substantial impact on quality of life and health care resources. The identification of a more cost-effective, yet equally efficacious, treatment could positively influence the economic burden of this disease. Fluticasone propionate/Formoterol (FP/FOR) may be as effective as Fluticasone Salmeterol (FP/SAL). We evaluated non-inferiority of asthma control in terms of the proportion of patients free from exacerbations, and conducted a cost impact analysis.

METHODS:

This historical, matched cohort database study evaluated two treatment groups in the Optimum Patient Care Research Database in the UK: 1) an FP/FOR cohort of patients initiating treatment with FP/FOR or changing from FP/SAL to FP/FOR and; 2) an FP/SAL cohort comprising patients initiating, or remaining on FP/SAL pMDI combination therapy. The main outcome evaluated non-inferiority of effectiveness (defined as prevention of severe exacerbations, lower limit of the 95% confidence interval (CI) of the mean difference between groups in patient proportions with no exacerbations is -3.5% or higher) in patients treated with FP/FOR versus FP/SAL.

RESULTS:

After matching 1:3, we studied a total of 2472 patients: 618 in the FP/FOR cohort (174 patients initiated on FP/FOR and 444 patients changed to FP/FOR) and 1854 in the FP/SAL cohort (522 patients initiated FP/SAL and 1332 continued FP/SAL). The percentage of patients prescribed FP/FOR met non-inferiority as the adjusted mean difference in proportion of no severe exacerbations (95%CI) was 0.008 (-0.032, 0.047) between the two cohorts. No other significant differences were observed except acute respiratory event rates, which were lower for patients prescribed FP/FOR (rate ratio [RR] 0.82, 95% CI 0.71, 0.94).

CONCLUSIONS:

Changing to, or initiating FP/FOR combination therapy, is associated with a non-inferior proportion of patients who are severe exacerbation-free at a lower average annual cost compared with continuing or initiating treatment with FP/SAL.

KEYWORDS:

Asthma; Cost-effectiveness; Fixed-dose combination inhalers; Formoterol; GINA; Real-life

PMID:
28732831
DOI:
10.1016/j.rmed.2017.06.016
[Indexed for MEDLINE]

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