Research group in Pharmacology and Toxicology "INFARTO", Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia.
Department of Pediatrics, Hospital Infantil Concejo de Medellin, Medellin, Colombia.
J Asthma. 2022 Dec;59(12):2367-2374. doi: 10.1080/02770903.2021.2019266. Epub 2021 Dec 29.
Recent asthma guidelines, recommends for persistent asthma as first alternative low dose inhaled budesonide-formoterol maintenance and reliever over fixed combination of low doses inhaled corticosteroids - long-acting beta-agonist, or fixed-dose inhaled corticosteroids. Concerns arise as to which of the proposed alternatives has the best possible cost-effectiveness profile. This study aimed to assess the health and economic consequences of SMART, fixed combination, and fixed-dose inhaled corticosteroids in patients with moderate-severe persistent asthma.
A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs of SMART, fixed combination, and fixed-dose inhaled corticosteroids were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.
The model suggests a potential gain of 1.27 and 1.34 QALYs per patient per year on SMART respect to fixed combination and fixed-dose ICS respectively. We observed a reduction of US$4 in total discounted cost per person-year on SMART with respect to fixed combination and US$0.1 respect to fixed-dose ICS. In the deterministic and probabilistic sensitivity analyses, our base-case results were robust to variations of all assumptions and parameters.
SMART therapy was found to be cost-effective regarding fixed combination and fixed-dose inhaled corticosteroids. This evidence supports the use of SMART therapy in Colombia and must to be replicated in others middle-income countries.
最近的哮喘指南建议，对于持续性哮喘，首选低剂量吸入布地奈德-福莫特罗维持治疗和缓解药物，而不是低剂量吸入皮质类固醇-长效β激动剂的固定复方制剂，或固定剂量吸入皮质类固醇。人们对所提出的替代方案中哪一种具有最佳的成本效益比提出了关注。本研究旨在评估 SMART、固定复方制剂和固定剂量吸入皮质类固醇在中重度持续性哮喘患者中的健康和经济后果。
创建了一个概率马尔可夫模型，以评估持续性哮喘患者的成本和质量调整生命年（QALYs）。计算了 SMART、固定复方制剂和固定剂量吸入皮质类固醇在终生范围内的总成本和 QALYs。进行了多次敏感性分析。以 19000 美元的支付意愿值评估成本效益。
模型表明，与固定复方制剂相比，SMART 每年可为每位患者增加 1.27 个 QALYs，与固定剂量 ICS 相比则增加 1.34 个 QALYs。与固定复方制剂相比，SMART 每年每人的总折扣成本降低了 4 美元，与固定剂量 ICS 相比则降低了 0.1 美元。在确定性和概率敏感性分析中，我们的基本情况结果对所有假设和参数的变化都具有稳健性。
与固定复方制剂和固定剂量吸入皮质类固醇相比，SMART 治疗具有成本效益。这一证据支持在哥伦比亚使用 SMART 治疗，并需要在其他中等收入国家进行复制。
