Background: Inhaled corticosteroids remain underused among United States-based clinicians in treating mild-to-moderate adult asthma. Objective: The purpose of this investigation was to estimate the clinical impact, health-related quality of life, cost, and cost-effectiveness of inhaled corticosteroid therapy in a population of patients aged 18 years and over with FEV1 = 60% to 100% of predicted normal. Methods: We performed a cost-effectiveness analysis of quick relievers (eg, short-acting β-agonists) on an as-needed basis plus inhaled corticosteroid therapy versus quick relievers alone. A mathematical simulation model was developed to forecast symptoms, acute exacerbations, quality-adjusted life-years (QALYs), health care costs, and cost-effectiveness, measured in both dollars per QALY gained and dollars per symptom-free day gained. All evaluation outcomes were discounted at an annual rate of 3% and measured over a 10-year planning horizon. Data on the natural history of disease, drug efficacy, patient preferences, and economic costs were obtained from a variety of observational cohorts, randomized trials, and patient surveys. Results: Over a 10-year period, use of inhaled corticosteroids increases total health costs from roughly $5,200 to $8,400 and improves QALYs from 6.8 to 7.0, implying an incremental cost of $13,500 per QALY gained. Costs per symptom-free day gained are $7.50. Both per-person acute exacerbations and hospitalizations are reduced by 33%. The cost-effectiveness findings are sensitive to the assumed efficacy and side-effects of inhaled corticosteroid therapy. Conclusions: Inhaled corticosteroids appear to deliver good comparative value in adults with mild-to-moderate asthma. Although more research is needed to understand their impact on preferences regarding side effects and compliance, these findings might be useful for priority-setting in limited resource situations.
Bibliographical noteFunding Information:
Financial support for this study was provided by a grant from AstraZeneca to the Brigham and Women’s Hospital. The funding agreement ensured the independence of the authors in designing the study, interpreting the data, and writing and publishing the report without prior approval. Dr Fuhlbrigge also received support from grant 1-K08 HL03919-01 from the National Heart Lung and Blood Institute, National Institutes of Health.
- Cost-effectiveness analysis
- Decision analysis
- Inhaled corticosteroids
- Markov models