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Economic Evaluation for Fluticasone (Propionate)/Formoterol (Flutiform®) vs
Fluticasone/Salmeterol and Budesonide/Formoterol in Spain
Martínez-Moragón E1, Delgado J2, Ojeda P3; Pérez del Llano L4, Antón C5, Martín C5, Collar JM6
1Hospital
Dr. Peset, Valencia, Spain; 2Hospital Virgen Macarena, Sevilla, Spain; 3 Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain; 4Complexo Hospitalario
Lucus Augusti, Lugo, Spain; 5Universidad Francisco de Vitoria, Madrid, Spain: 6Mundipharma Pharmaceuticals, S.L., Madrid, Spain.
INTRODUCTION & OBJECTIVES
RESULTS
Asthma is one of the chronic respiratory diseases that has a higher impact in public
health 1. The average prevalence in Spain is 5.7% but depending on the geographical
area it can reach a 10%2 . Entails a high sanitary and non-sanitary resources
consumption, in which the pharmacological treatment represents around a 33% 3.
The Spanish and International guidelines recommend the usage of Inhaled
Corticosteroids (ICS) and long-acting beta-2 adrenergic (LABA) bronchodilators as
maintenance therapy in patients with moderate to severe persistent asthma4,5.
Although these treatments have proven efficacy, around a 50% has a suboptimal control
5, increasing the pathology management cost.
The aim of this economic evaluation is to estimate the cost-effectiveness of three
ICS/LABA fixed-dose combinations: fluticasone propionate/ formoterol (Flutiform®)
(FPF ) versus fluticasone /salmeterol (FS) and budesonide/ formoterol (BF) in the
treatment of adult patients with moderate to severe asthma from the perspective of the
Society in Spain.
FPF drug acquisition cost was lower (20% compared to FS and 30% compared to BF),
meanwhile QALY of the three alternatives compared were very similar. Cost per patient
on the FPF cohort yielded €9.326/year, lower either than FS (€137) or than BF (€247),
being the most economical alternative. The sub-optimal control health state was the
mainstay of cost (80% of the total cost) in any of the analysed alternatives and
scenarios.
PSA results confirmed the data from the base case scenario. FPF is more efficient than
FS and BF, with a probability of 52.6% and 57.6%, respectively at any acceptability
threshold.
Figure 2. FPF/FS and FPF/BF Cost- effectiveness planes.
METHODS
A Markov model was developed with five asthma health states: successful control, suboptimal control, outpatient-managed exacerbation, inpatient-managed exacerbation,
and death. Time horizon was set at 12 months and weekly probability transitions. Direct
and indirect resources consumption and unitary cost data were obtained from
published studies, an expert panel and autonomous communities prices weighted by
population, all expressed in 2014 euros.
The comparative studies between FPF and the other two ICS/LABA combinations
confirmed the same efficacy at equivalent doses between them and a rapidly onset of
action than BF 6-12.
Effectiveness was expressed as quality-adjusted life years (QALY) gained and the results
were assess with the incremental cost effectiveness ratio (ICER).
FPF
FPF
FS
FS
Figure 1: Markov model diagram.
QALYs: Quality Adjusted Life-Years; FPF: Fluticasone(Proponiate)/Formoterol; FS: Fluticasone/Salmeterol; BF: Budesonide /Formoterol
Table 3. Base case probabilistic and deterministic results.
Table 1: Transition probability matrix10 and state utilities12.
Probabilities
SC
SOC
OME
IME
D
Utilities
SC
0.89407
0.15049
0.22784
0.33332
0
0.85
SOC
0.0986
0.82982
0.54401
0.33332
0
0.77
OME
0.00702
0.01938
0
0
0
0.66
IME
0.00027
0.00027
0
0
0
0.59
D
4E-05
4E-05
0.22815
0.33336
1
0
SC: Successful control; SOC: Sub-optimal control; OME: Outpatient-manage exacerbation; IME: Inpatient-manage
exacerbation; D: Death.
With a 53% and 47% patients initial distribution between SC and SOC 11 and 1.23 and
5.33 weekly home management exacerbations respectively (expert panel).
Rescues
SC Cost
SOC Cost
OME Cost
IME Cost
Total Cost
QALY´s
Rescues
SC Cost
SOC Cost
OME Cost
IME Cost
Total Cost
QALY´s
FPF
13.41
1,251.32
7,674.84
578.89
62.81
9,567.86
0.78
Probabilistic Analysis
BF
% FPF vs BF
FPF
13.41
0.0%
13.54
1,356.85
8.4%
1,258.42
7,828.76
2.0%
7,742.11
584.93
1.0%
585.39
62.92
0.2%
63.37
9,833.46
2.8%
9,649.29
0.78
0.0%
0.78
FS
13.54
1,336.88
7,767.11
586.58
63.49
9,753.97
0.78
% FPF vs BF
0.0%
6.2%
0.3%
0.2%
0.2%
1.1%
0.0%
FPF
13.11
1,217.30
7,481.49
61.36
61.36
9,326.39
0.76
Deterministic Analysis
BF
% FPF vs BF
FPF
13.11
0.0%
13.11
1,348.14
10.7%
1,217.30
7,585.30
1.4%
7,481.49
61.50
1.1%
61.36
61.50
0.2%
61.36
9,567.35
2.6%
9,326.39
0.76
0.0%
0.76
FS
13.11
1,284.31
7,548.40
61.43
61.43
9,463.51
0.76
% FPF vs BF
0.0%
5.5%
0.9%
0.6%
0.1%
1.5%
0.0%
FPF: Fluticasone (Propionate)/Formoterol; FS: Fluticasone/Salmeterol; BF: Budesonide /Formoterol; SC: Successful control; SOC: Suboptimal control; OME: Outpatient-manage exacerbation; IME: Inpatient-manage exacerbation; D: Death.
Table 2: Social perspective state and therapeutic alternative maintenance and total
cost (botplus and official Regional prices).
SC
SOC
OME
IME
SC
SOC
OME
IME
FPF
FS
Maintenance Treatment Cost
9.56
11.89
14.34
17.84
22.30
27.75
22.30
27.75
Total Cost
42.16
44.50
384.00
387.50
985,78
991.23
4739,59
4745.04
BF
14.16
21.24
33.03
33.03
46.76
390.90
996.52
4750.32
FF: Fluticasone (Propionate)/ Formoterol FS:Fluticasone/Salmeterol BF:
Budesonide/Formoterol; SC: Successful control; SOC: Sub-optimal control; OME:
Outpatient-manage exacerbation; IME: Inpatient-manage exacerbation; D: Death.
Uncertainty from the social and payer perspective was tested with univariate and
probabilistic sensitivity analysis (PAS) to ensure the strength of the model.
18th Annual European Congress 7-11 November 2015 Milan, Italy.
CONCLUSIONS
From the Spanish societal perspective in year 2014, FPF produced similar QALY gain at a
lower cost when compared with FS and BF in a highly meaningful number of replications
and scenarios. FPF may be considered a cost-effective alternative in the treatment of
moderate to severe asthma in Spain. The cost savings were mainly due to significant FPF
lower price acquisition costs compared to the other two alternatives
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