Objective
To estimate the cost-effectiveness of beclomethasone/formoterol (BDP/F) versus fluticasone/salmeterol (F/S) in the treatment of adult outpatients with moderate-to-severe asthma from the Spanish society perspective.
Methods
A 12-week horizon Markov model was developed with five asthma health states as per the GINA/GEMA classification: successful control, suboptimal control, uncontrolled (with/without hospitalization), and death. Weekly transition probabilities were derived from the ICAT-SE study. Resources utilization were obtained from a published Spanish study designed ad hoc to ascertain healthcare resources utilization, the so-called lost-workday-equivalents, and corresponding costs related with treatment of asthma. Effectiveness was expressed as quality-adjusted-life years (QALYs) gain. The cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) with its 95% confidence interval being calculated through resampling ( bootstrapping ) techniques that allowed obtaining its cost-effectiveness acceptability curve. Univariate and probabilistic sensitivity analyses were applied.
Results
Compared with F/S, BDP/F was associated with a slightly increase in QALY gain; 0.0276 versus 0.0251, while differential costs were lower favouring BDP/F, €421 versus €454 ( p <0,001), and yielded a mean ICER of €−12,336 (€−70,087; €+58,827) per QALY gained. In 96.3% of resamples, the ICER was below the threshold of €30,000/QALY. Univariate and probabilistic sensitivity analyses were robust and confirmed the results of the base case scenario.
Conclusions
From the Spanish societal and NHS perspectives in year 2012, BDP/F may be considered a cost-effective alternative compared to F/S in the treatment of moderate-to-severe asthma in Spain, as it produced a slight QALY gain at a lower cost in a highly meaningful number of replications and scenarios.