inhaled corticosteroids cost saving in children with asthma

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PharmacoEconomics & Outcomes News 30 - 10 Jun 1995 1. Perera BJC. Efficacy and cost effectiveness of inhaled steroids in asthma in a Inhaled 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 in in 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 Perera from Sri Lanka. 1 His 4-year, randomised study involved 86 children with moderate-to-severe asthma. Prior to study implementation, children received long-term treatment with either oral β-agonists (n = 84), oral theophylline (72) or short-term repeated courses of IV or oral corticosteroids (81). During the study, 48 patients received inhaled beclomethasone (mean starting dose of 485 µg/day) and 38 received budesonide (mean starting dose of 450 µg/day). After an average of 6 and 5.5 months, respectively, the dosages were reduced to maintenance levels of 300 µg/day and 261 µg/day. Favourable cost and utility values 67 patients (78%) had a excellent response to inhaled corticosteroid therapy, with no further breakthrough wheezing, loss of schooling, hospitalisation or acute severe attacks. Notably, the mean treatment cost decreased from £36.33/patient/month before starting inhaled corticosteroid therapy to £6.16/patient/month after therapy. * In an accompanying commentary, Anthony Costello and David Woodward from the Institute for Child Health, London, UK, note that £6/ patient seems a ‘remarkably low’ value. 2 Parents’ satisfaction with their child’s response to treatment increased from 15% before commencing inhaled corticosteroid therapy to 90% after commencing therapy. 1 Thus, the cost utility associated with antiasthmatic therapy decreased from £3.50 to £0.07/ patient following corticosteroid therapy. ‘One cannot conclude that inhaled steroid treatment for prophylaxis of asthma is a cost effective treatment . . . without considering some of the limitations of the study’, say Messeurs Costello and Woodward. 2 They list the following points as potential study limitations. The study sample was unrepresentative of the general population – the parents of most patients were in the upper income group. The study was a comparison of inhaled corticosteroids and a multidrug regimen. At least 75% of patients received oral β-agonists, oral theophylline and repeat courses of IV or oral corticosteroids. This pattern of drug use is likely to be very different from that in the Sri Lankan public healthcare sector or in other developing countries (i.e. the treatment regimen is more intensive than expected in the public sector). An important issue in a resource constrained public healthcare system is the separation of healthcare sector and patient costs. These costs were not separated in the study, note Messeurs Costello and Woodward. Overall, they believe that Dr Perera’s study is of value and relevance to clinicians and healthcare planners in developing countries where cost effectiveness is a critical part of any planning decision. * Costs included those relating to medical consultations, drug acquisition, hospitalisation, travelling and loss of parental work. 1 PharmacoEconomics & Outcomes News 10 Jun 1995 No. 30 1173-5503/10/0030-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Page 1: Inhaled corticosteroids cost saving in children with asthma

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