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Country-specific cost-effectiveness of early intervention with budesonide in mild asthma

¹ Health Economics Research Group, Brunel University, Uxbridge, UK. ² Depts of Pharmacy and Health Services, University of Washington, Seattle, WA, ⁴ University of Wisconsin, Madison, WI, ⁶ The Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, and the Center for Healthcare Studies, Northwestern University Medical School, Chicago, IL, USA. ³ AstraZeneca R&D, Lund, Sweden. ⁵ Dept of Paediatrics, Kolding Hospital, Kolding, Denmark.

CORRESPONDENCE: M. Buxton, Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK. Fax: 44 1895269708. E-mail: martin.buxton@brunel.ac.uk

Keywords: Budesonide, cost-effectiveness, early intervention, inhaled Steroid Treatment As Regular Therapy in early asthma, international

Received: September 25, 2003
Accepted June 16, 2004

This study was fully funded by AstraZeneca R&D, Lund, Sweden. The sponsors of the study had no role in the design, analysis and interpretation of the results of this cost-effectiveness study, with the exception of the company co-authors who participated in all aspects of the study. All investigators had free and unlimited access to the raw data and statistical reports.

Early intervention with budesonide is an effective strategy for mild persistent asthma, which has been shown to provide additional clinical benefits at a low incremental cost using USA cost data. The present authors analysed whether this strategy would be cost-effective using cost data for other countries.

Based on the 3-yr prospective, randomised, double-blind inhaled Steroid Treatment As Regular Therapy (START) in early asthma study (comparing budesonide and placebo combined with usual asthma therapy), the cost-effectiveness was estimated separately for eight different countries, from both healthcare payer and societal perspectives, of adding budesonide to usual asthma therapy. Local unit costs were applied to data for the total trial population. Incremental cost-effectiveness ratios (ICER) were estimated as cost per symptom-free day (SFD) gained.

Budesonide increased SFDs by an average of 14.1 days annually. From a healthcare payer perspective, budesonide would reduce the total cost of asthma care in Australia. In Sweden, Canada, France, Spain, UK, China and the USA, the ICER ranged from US$2.4–11.3 per SFD. From a societal perspective, budesonide would be cost-saving in Australia, Canada and Sweden.

In conclusion, for countries where costs with budesonide are higher, the policy implication has to be determined by that health system's willingness to pay for an additional symptom-free day. However, where budesonide therapy increases symptom-free days and reduces total costs, the policy conclusion clearly favours early intervention.