Pharmaco-economical trial of a new concept of administration of Symbicort in patients with bronchial asthma

Abstract

SMART concept implies administration of Symbicort (budesonid/formoterol both as maintenance and reliever therapy of asthma (BA). The present study was designed to evaluate economic efficacy of SMART regimen (Symbicort 320 / 9 or 640 / 18 μg daily plus Symbicort 160 / 4.5 as needed) compared with current practice of asthma therapy in Russia (64 different medications administered in real practice in 34 cities of Russian federation in 2005) and combined therapy with Seretid Multidisk (fluticason / salmeterol 200 / 100 to 1000 / 100 μg daily plus salbutamol as needed). We performed economic analysis of SMART regimen based on the results of international multi center randomized COSMOS trial. We assessed direct medical costs (outpatient pharmacotherapy with the given medications, emergency care for asthma exacerbations, related hospitalisations, scheduled visits to a physician) and non medical expenses and losses (social expenses for temporary disability, loss of income tax for state budget and of non produced gross national product). As a result, cost of SMART regimen was 1.2 fold to 1.4 fold higher than that of the routine therapy but the former has been eventually decreased by 15 % due to reduction in as needed doses. The mean dose of Seretid did not changed in time but the total expenses for the drug therapy became 20 % higher when compared with SMART regimen and 1.5 fold higher when compared with the routine therapy. The BA burden, which is a sum of treatment cost and social expenses related to the disease, in routinely treated patients were 2 fold to 3 fold higher than in SMART patients. Therefore, combined drugs for management of BA (Symbicort SMART and Seretid) have great medical and economical advantaged over the routine therapy.