Cost-effectiveness of asthma control: an economic appraisal of the GOAL study

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Briggs, A.H. ; Bousquet, J. ; Wallace, M. ; Busse, W.W. ; Clark, T.J.H. ; Pedersen, S.E. ; Baternan, E.D. (2006)

<i>Background</i>: The Gaining Optimal Asthma ControL (GOAL) study has shown the superiority of a combination of salmeterol/fluticasone propionate (SFC) compared with fluticasone propionate alone (FP) in terms of improving guideline defined asthma control.\ud \ud <i>Methods</i>: Clinical and economic data were taken from the GOAL study, supplemented with data on health related quality of life, in order to estimate the cost per quality adjusted life year (QALY) results for each of three strata (previously corticosteroid-free, low- and moderate-dose corticosteroid users). A series of statistical models of trial outcomes was used to construct cost effectiveness estimates across the strata of the multinational GOAL study including adjustment to the UK experience. Uncertainty was handled using the non-parametric bootstrap. Cost-effectiveness was compared with other treatments for chronic conditions.\ud \ud <i>Result</i>: Salmeterol/fluticasone propionate improved the proportion of patients achieving totally and well-controlled weeks resulting in a similar QALY gain across the three strata of GOAL. Additional costs of treatment were greatest in stratum 1 and least in stratum 3, with some of the costs offset by reduced health care resource use. Cost-effectiveness by stratum was £7600 (95% CI: £4800–10 700) per QALY gained for stratum 3; £11 000 (£8600–14 600) per QALY gained for stratum 2; and £13 700 (£11 000–18 300) per QALY gained for stratum 1.\ud \ud <i>Conclusion</i>: The GOAL study previously demonstrated the improvement in total control associated with the use of SFC compared with FP alone. This study suggests that this improvement in control is associated with cost-per-QALY figures that compare favourably with other uses of scarce health care resources.
  • References (16)
    16 references, page 1 of 2

    1. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J 2000;16:802-807.

    2. Bateman ED, Frith LF, Braunstein GL. Achieving guideline-based asthma control: does the patient benefit? Eur Respir J 2002;20:588-595.

    3. Holt S, Kljakovic M, Reid J. Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS). N Z Med J 2001;116:U436.

    4. Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJH, Pauwels RA et al. Can guideline-defined asthma control be achieved? The gaining optimal asthma control study. Am J Respir Crit Care Med 2004;170:836-844.

    5. Global Initiative for Asthma (GINA). Pocket Guide for Asthma Management and Prevention. Publication No. 95- 3659-B. Bethesda: National Institutes for Health, National Heart, Lung and Blood Institute, 1998.

    6. National Institute for Clinical Excellence (NICE). Guide to the Methods of Technology Assessment. London: NICE, 2004, available at: http:// www.nice.org.uk/pdf/TAP_Methods.pdf (Accessed 29 November 2005).

    7. Agresti A. An Introduction to Categorical Data Analysis. New York: John Wiley & Sons, 1996.

    8. Armitage P, Berry G. Statistical Methods in Medical Research, 3rd edn. Oxford: Blackwell Scientific Publications, 1994.

    9. Chan YH. Biostatistics 305. Multinomial logistic regression. Singapore Med J 2005;46:259-268.

    10. Curtis L, Netten A. Unit Costs of Health and Social Care, 12 edn. Canterbury: Personal and Social Services Research Unit, University of Kent, 2004, available at: http://www.psssru.ac.uk/ publications.htm (Accessed 29 November 2005).

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