Abstract
BackgroundAn important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (triple therapy) to treatment with high doses of inhaled corticosteroids-long-acting beta2-agonist (dual therapy). The purpose of this study was to assess the cost-effectiveness of triple therapy versus dual therapy for patients with severe asthma.MethodsA probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of dual and triple therapy were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.ResultsThe model suggests a potential gain of 1.55 QALYs per patient per year on triple therapy with respect to dual therapy. We observed a difference of US$304 in discounted cost per person-year on triple therapy with respect to dual therapy. The incremental cost-effectiveness ratio was US$196 in the probabilistic model. In the sensitivity analysis, our base‐case results were robust to variations in all assumptions and parameters.ConclusionIn conclusion, triple therapy in patients with moderate-severe asthma was cost-effective. Using triple therapy emerges with our results as an alternative before using oral corticosteroids or biologics, especially in resource-limited settings.
Highlights
An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists
At least 24% of patients with asthma are classified as severe asthma requiring high doses of inhaled corticosteroids (ICS)-long-acting beta2-agonist (LABA) or ICS-LABA or oral corticosteroids (OCS) [2]
Base-case analyses showed that triple therapy was associated with higher costs and quality-adjusted life-years (QALYs) than dual therapy
Summary
An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. In these patients, using add-on long-acting muscarinic antagonists (LAMA) to treatment with ICS-LABA in severe asthma because this triple therapy (ICS + LABA + LAMA) because improves lung function, quality of life and increased the time to severe exacerbation requiring OCS [6,7,8,9]. This is a relevant alternative, insofar as it can prevent the patient from ending up using oral corticosteroids or high-cost biologic drugs. This study aimed to use to assess the health and economic consequences of dual inhaled therapy (LABA + ICS) versus triple inhaled therapy (LAMA + LABA + ICS) for the treatment of severe asthma in Colombia
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