PharmacoEconomics & Outcomes News 30 - 10 Jun 19951. Perera BJC. Efficacy and cost effectiveness of inhaled steroids in asthma in aInhaled corticosteroids cost saving developing country. Archives of Disease in Childhood 72: 312-315, Apr 1995.2. Costello A, et al. Efficacy and cost effectiveness of inhaled steroids in asthma inin children with asthma
a developing country: commentary. Archives of Disease in Childhood 72:315-316, Apr 1995.
Inhaled corticosteroids are clinically efficacious and 800314473
cost saving in children with asthma, says Dr BJC Pererafrom Sri Lanka.1
His 4-year, randomised study involved 86 childrenwith moderate-to-severe asthma. Prior to studyimplementation, children received long-term treatmentwith either oral β-agonists (n = 84), oral theophylline(72) or short-term repeated courses of IV or oralcorticosteroids (81). During the study, 48 patientsreceived inhaled beclomethasone (mean starting dose of485 µg/day) and 38 received budesonide (mean startingdose of 450 µg/day). After an average of 6 and 5.5months, respectively, the dosages were reduced tomaintenance levels of 300 µg/day and 261 µg/day.
Favourable cost and utility values67 patients (78%) had a excellent response to inhaled
corticosteroid therapy, with no further breakthroughwheezing, loss of schooling, hospitalisation or acutesevere attacks. Notably, the mean treatment costdecreased from £36.33/patient/month before startinginhaled corticosteroid therapy to £6.16/patient/monthafter therapy.* In an accompanying commentary,Anthony Costello and David Woodward from theInstitute for Child Health, London, UK, note that £6/patient seems a ‘remarkably low’ value.2
Parents’ satisfaction with their child’s response totreatment increased from 15% before commencinginhaled corticosteroid therapy to 90% after commencingtherapy.1 Thus, the cost utility associated withantiasthmatic therapy decreased from £3.50 to £0.07/patient following corticosteroid therapy.
‘One cannot conclude that inhaled steroidtreatment for prophylaxis of asthma is a cost effectivetreatment . . . without considering some of thelimitations of the study’, say Messeurs Costello andWoodward.2
They list the following points as potential studylimitations.• The study sample was unrepresentative of the
general population – the parents of most patientswere in the upper income group.
• The study was a comparison of inhaledcorticosteroids and a multidrug regimen. At least75% of patients received oral β-agonists, oraltheophylline and repeat courses of IV or oralcorticosteroids. This pattern of drug use is likely tobe very different from that in the Sri Lankan publichealthcare sector or in other developing countries(i.e. the treatment regimen is more intensive thanexpected in the public sector).
• An important issue in a resource constrained publichealthcare system is the separation of healthcaresector and patient costs. These costs were notseparated in the study, note Messeurs Costello andWoodward.
Overall, they believe that Dr Perera’s study is of valueand relevance to clinicians and healthcare planners indeveloping countries where cost effectiveness is acritical part of any planning decision.* Costs included those relating to medical consultations, drugacquisition, hospitalisation, travelling and loss of parental work.
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PharmacoEconomics & Outcomes News 10 Jun 1995 No. 301173-5503/10/0030-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
