Markham A, Adkins J C
Adis International Limited, Auckland, New Zealand.
Pharmacoeconomics. 2000 Dec;18(6):591-608. doi: 10.2165/00019053-200018060-00006.
Cost estimates from developed countries indicate that asthma accounts for up to 2% of the economic cost of all diseases. A large proportion of asthma-related costs are attributable to poor asthma control. Treatment strategies which improve clinical outcomes in patients with asthma, therefore, have the potential for significant economic benefits, and it is important to evaluate new asthma therapies for cost effectiveness. Several studies have established that salmeterol and fluticasone propionate combined in a single dry powder inhalation device are at least as effective as a combination of the 2 drugs administered via separate dry powder inhalers and more effective than monotherapy with fluticasone propionate or budesonide. Importantly, pharmacoeconomic analysis of several of these studies show that the salmeterol/fluticasone propionate combination is cost effective relative to monotherapy with fluticasone propionate or budesonide. Although the total cost of asthma management tended to be slightly higher with salmeterol/fluticasone propionate than with inhaled corticosteroid monotherapy, in most cases mean cost-effectiveness ratios were lower (i.e. more favourable) for salmeterol/fluticasone propionate than either fluticasone propionate or budesonide. Cost effectiveness was assessed according to 3 end-points: successfully treated weeks, symptom-free days and episode-free days. Mean cost-effectiveness ratios consistently favoured salmeterol/fluticasone propionate over the comparator drug for the end-point successfully treated weeks, and in most cases the other 2 end-points also favoured the combination product over the comparator. In a further study, salmeterol/fluticasone was also less costly than therapy with formoterol and budesonide administered via 2 separate inhalers. Studies of health-related quality of life (HR-QOL) using the Asthma Quality of Life Questionnaire indicate that salmeterol/fluticasone propionate produces clinically meaningful improvements in overall HR-QOL relative to salmeterol monotherapy or placebo. Improvements in overall HR-QOL were statistically significantly greater for salmeterol/fluticasone propionate than with fluticasone propionate or budesonide alone, although the differences between treatments did not exceed the threshold for clinical significance. In conclusion, short term cost-effectiveness data show that salmeterol/fluticasone propionate is more cost effective than the inhaled corticosteroids budesonide and fluticasone propionate alone. The combination product also appears to improve HR-QOL relative to placebo or salmeterol alone.
来自发达国家的成本估算表明，哮喘占所有疾病经济成本的比例高达2%。很大一部分与哮喘相关的成本可归因于哮喘控制不佳。因此，能够改善哮喘患者临床结局的治疗策略具有显著的经济效益潜力，评估新的哮喘治疗方法的成本效益非常重要。多项研究证实，沙美特罗和丙酸氟替卡松联合在单一干粉吸入装置中，至少与通过单独的干粉吸入器分别给药这两种药物的联合疗法一样有效，且比丙酸氟替卡松或布地奈德单药治疗更有效。重要的是，其中几项研究的药物经济学分析表明，相对于丙酸氟替卡松或布地奈德单药治疗，沙美特罗/丙酸氟替卡松联合疗法具有成本效益。虽然使用沙美特罗/丙酸氟替卡松的哮喘管理总成本往往比吸入性糖皮质激素单药治疗略高，但在大多数情况下，沙美特罗/丙酸氟替卡松的平均成本效益比低于丙酸氟替卡松或布地奈德（即更有利）。根据3个终点评估成本效益：成功治疗周数、无症状天数和无发作天数。对于成功治疗周数这一终点，沙美特罗/丙酸氟替卡松的平均成本效益比始终优于对照药物，在大多数情况下，其他2个终点也显示联合产品优于对照药物。在另一项研究中，沙美特罗/丙酸氟替卡松的成本也低于通过2个单独吸入器给予福莫特罗和布地奈德的治疗方法。使用哮喘生活质量问卷对健康相关生活质量（HR-QOL）进行的研究表明，相对于沙美特罗单药治疗或安慰剂，沙美特罗/丙酸氟替卡松可使整体HR-QOL产生具有临床意义的改善。沙美特罗/丙酸氟替卡松在整体HR-QOL方面的改善在统计学上显著大于单独使用丙酸氟替卡松或布地奈德，尽管治疗之间的差异未超过临床意义阈值。总之，短期成本效益数据表明，沙美特罗/丙酸氟替卡松比单独使用吸入性糖皮质激素布地奈德和丙酸氟替卡松更具成本效益。相对于安慰剂或单独使用沙美特罗，联合产品似乎也能改善HR-QOL。
