COSTS AND EFFECTS OF INHALED CORTICOSTEROIDS AND BRONCHODILATORS IN ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

The objective of this study was to determine the costs and effects of combined bronchodilator and antiinflammatory therapy. In a 2.5-yr randomized controlled study, combined beta(2)-agonist/corticosteroid therapy (BA + CS) and combined beta(2)-agonist/anticholinergic therapy(BA + AC) were compared with beta(2)-agonist/ placebo therapy (BA + FL). Included in the study were 274 patients 18 to 60 yr of age with moderately severe obstructive airways disease. The main clinical endpoints were lung function, hyperresponsiveness, restricted activity days, and symptom-free days. The economic endpoints were the costs of health care utilization. Compared with BA + FL, BA + CS led to significant improvements in FEV(1), PC20, and symptom-free days. BA + AC did not differ from BA + PL in this respect. The respective annual acquisition costs of BA + CS, BA + AC, and BA + PL were 532 US$, 277 US$, and 156 US$. Thus, BA + CS costs 376 US$ more than BA + FL. However, compared with BA + PL therapy, BA + CS led to statistically significant savings in other health care costs of about 175 US$ (95% CI from 46 to 303 US$). Thus, more than half of the additional costs of adding the inhaled corticosteroid are compensated for by a reduction in the costs of other health care services. Overall, inhaled corticosteroids lead to a small but net increase in health care costs of 201 US$ per patient per year. The incremental cost-effectiveness ratio of BA + CS compared with BA + PL ranges from 200 US$ per 10% increase in FEV(1) to 5 US$ per symptom-free day gained. In order to reach net societal savings the economic benefits of increased productivity due to inhaled corticosteroids have to be valued higher than 42 US$ per day. No significant differences in health care costs were found between the BA + AC and BA + PL groups. It can be concluded that the addition of an inhaled corticosteroid to a beta(2)-agonist leads to significant benefits in respiratory function and restricted activity days, which seem to be worth the relatively low additional health care costs, whereas addition of an anticholinergic agent appears expensive and of no long-term value.