Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark – Cost‐effectiveness analysis based on five randomised controlled trials

Background and Aims:  Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART®) is an effective asthma‐management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations. The aim of this study was to determine the cost‐effectiveness of the Symbicort SMART® regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long‐acting β 2 ‐agonist (ICS/LABA) combination therapy plus reliever medication or higher dose of inhaled ICS/LABA combination therapy plus reliever medication. Methods:  The cost‐effectiveness analyses were based on effectiveness and resource utilisation data, which were prospectively collected during the treatment period in five randomised clinical trials (duration: 24 weeks, 26 weeks or 1 year). Economic analyses were conducted from both a health care sector (direct costs) and a societal perspective [total costs, i.e direct costs + indirect costs (sick leave)]. The time horizon for the economic analyses was 1 year. The effectiveness measure used was the number of avoided severe exacerbations per patient per year. Results:  Patients treated with budesonide/formoterol maintenance and reliever therapy showed statistically significant fewer severe exacerbations per patient compared with the alternative treatment regimes in all comparisons. Budesonide/formoterol maintenance and reliever therapy was a dominant treatment option when compared with higher dose ICS or higher dose ICS/LABA, i.e. it was more effective at a lower total cost. In two of the three comparisons with a similar ICS/LABA dose, Symbicort SMART® was dominant. Conclusion:  Cost‐effectiveness analyses of budesonide/formoterol maintenance and reliever therapy show that the significant reduction in the number of severe exacerbations observed in all the included clinical studies is predominately obtained at lower costs compared with alternative treatment regimes. This indicates that budesonide/formoterol maintenance and reliever therapy is a cost‐effective treatment option in a Danish setting. Please cite this paper as: Wickstrøm J, Dam N, Malmberg I, Hansen BB and Lange P. Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark – Cost‐effectiveness analysis based on five randomised controlled trials. The Clinical Respiratory Journal 2009; 3: 169–180.