Lyseng-Williamson Katherine A, Plosker Greg L
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
Pharmacoeconomics. 2003;21(13):951-89. doi: 10.2165/00019053-200321130-00004.
Asthma guidelines recommend an inhaled corticosteroid plus a long-acting inhaled beta(2)-agonist (beta(2)-adrenoceptor agonist) as the preferred maintenance therapy for moderate and severe persistent asthma. Advair/Seretide Diskus also registered as Accuhaler is fixed-dose salmeterol (a long-acting inhaled beta(2)-agonist) and fluticasone propionate (a corticosteroid) administered via a single powder inhalation device. The clinical effectiveness of salmeterol/fluticasone propionate in patients with persistent asthma symptoms has been established in comparative clinical trials. Pharmacoeconomic analyses, based on data from these clinical trials, have been conducted from a healthcare payer perspective in various countries. In patients with asthma not controlled with inhaled corticosteroids, salmeterol/fluticasone propionate was associated with more favourable (lower) cost-effectiveness ratios than fluticasone propionate monotherapy, oral montelukast plus inhaled fluticasone propionate, inhaled budesonide, and inhaled formoterol plus budesonide. As the initial maintenance therapy in patients with persistent asthma symptoms while receiving short-acting beta(2)-agonists alone, salmeterol/fluticasone propionate was cost effective relative to montelukast monotherapy. Although the total cost of asthma management tended to be slightly higher with salmeterol/fluticasone propionate than with fluticasone propionate or montelukast monotherapy, salmeterol/fluticasone propionate consistently had a more favourable cost-effectiveness ratio in terms of per successfully treated week or symptom-free day and/or was associated with small incremental costs to achieve significant additional clinical benefits. In clinical practice, salmeterol plus fluticasone propionate was associated with lower asthma-related costs than treatment with other maintenance therapies.In patients with asthma symptoms despite treatment with inhaled corticosteroids, salmeterol/fluticasone propionate produced clinically meaningful improvements in overall Asthma Quality of Life Questionnaire (AQLQ) scores relative to salmeterol or placebo monotherapy, in emotional function domain scores relative to fluticasone propionate or budesonide, and in asthma symptoms domain scores relative to budesonide. In patients with persistent asthma symptoms while receiving short-acting beta(2)-agonists alone, salmeterol/fluticasone propionate produced clinically meaningful improvements in overall AQLQ scores compared with fluticasone propionate or montelukast.
Pharmacoeconomic analyses indicate that salmeterol/fluticasone propionate administered via a single inhaler represents a cost-effective treatment option (relative to fluticasone propionate at the same nominal dosage, budesonide, formoterol plus budesonide and montelukast plus fluticasone propionate) in patients with asthma not controlled with inhaled corticosteroid therapy. In patients with asthma not controlled with short-acting beta(2)-agonists alone, salmeterol/fluticasone propionate is a cost effective treatment relative to monotherapy with montelukast. Importantly, salmeterol/fluticasone propionate is also associated with improvements in health-related quality of life.
哮喘指南推荐吸入性糖皮质激素加长效吸入型β₂受体激动剂作为中度和重度持续性哮喘的首选维持治疗方案。舒利迭/信必可都保也以准纳器形式注册，是通过单一干粉吸入装置给药的固定剂量沙美特罗（长效吸入型β₂受体激动剂）和丙酸氟替卡松（一种糖皮质激素）。沙美特罗/丙酸氟替卡松在持续性哮喘症状患者中的临床疗效已在比较临床试验中得到证实。基于这些临床试验数据，已从不同国家医疗保健支付方的角度进行了药物经济学分析。在未用吸入性糖皮质激素控制的哮喘患者中，沙美特罗/丙酸氟替卡松与更有利（更低）的成本效益比相关，优于丙酸氟替卡松单药治疗、口服孟鲁司特加吸入性丙酸氟替卡松、吸入性布地奈德以及吸入性福莫特罗加布地奈德。作为仅接受短效β₂受体激动剂治疗的持续性哮喘症状患者的初始维持治疗，沙美特罗/丙酸氟替卡松相对于孟鲁司特单药治疗具有成本效益。尽管沙美特罗/丙酸氟替卡松的哮喘管理总成本往往比丙酸氟替卡松或孟鲁司特单药治疗略高，但就每成功治疗一周或无症状天数而言，沙美特罗/丙酸氟替卡松始终具有更有利的成本效益比，和/或实现显著额外临床益处的增量成本较小。在临床实践中，沙美特罗加丙酸氟替卡松与其他维持治疗相比，哮喘相关成本更低。在尽管接受吸入性糖皮质激素治疗仍有哮喘症状的患者中，相对于沙美特罗或安慰剂单药治疗，沙美特罗/丙酸氟替卡松在总体哮喘生活质量问卷（AQLQ）评分方面产生了具有临床意义的改善；相对于丙酸氟替卡松或布地奈德，在情绪功能领域评分方面产生了改善；相对于布地奈德，在哮喘症状领域评分方面产生了改善。在仅接受短效β₂受体激动剂治疗的持续性哮喘症状患者中，与丙酸氟替卡松或孟鲁司特相比，沙美特罗/丙酸氟替卡松在总体AQLQ评分方面产生了具有临床意义的改善。
药物经济学分析表明，对于未用吸入性糖皮质激素治疗控制的哮喘患者，通过单一吸入器给药的沙美特罗/丙酸氟替卡松是一种具有成本效益的治疗选择（相对于相同标称剂量的丙酸氟替卡松、布地奈德、福莫特罗加布地奈德以及孟鲁司特加丙酸氟替卡松）。对于未用短效β₂受体激动剂控制的哮喘患者，相对于孟鲁司特单药治疗，沙美特罗/丙酸氟替卡松是一种具有成本效益的治疗方法。重要的是，沙美特罗/丙酸氟替卡松还与健康相关生活质量的改善相关。
