Cost-effectiveness of budesonide-formoterol vs inhaled epinephrine in US adults with mild asthma.

Autor:	Ho JK; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada., Shaker M; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Greenhawt M; Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado., Sadatsafavi M; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada., Abrams EM; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada., Oppenheimer J; University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, Newark, New Jersey., Mosnaim GS; Division of Allergy, Asthma, and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois., Lee TY; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada., Johnson KM; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: Kate.johnson@ubc.ca.
Jazyk:	angličtina
Zdroj:	Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology [Ann Allergy Asthma Immunol] 2024 Feb; Vol. 132 (2), pp. 229-239.e3. Date of Electronic Publication: 2023 Oct 23.
DOI:	10.1016/j.anai.2023.10.024
Abstrakt:	Background: The management of mild asthma has lacked an over-the-counter (OTC) option aside from inhaled epinephrine, which is available in the United States. However, inhaled epinephrine use without an inhaled corticosteroid may increase the risk of asthma death. Objective: To compare the cost-effectiveness of OTC as-needed budesonide-formoterol as a plausible alternative to inhaled epinephrine. Methods: We developed a probabilistic Markov model to compare OTC as-needed budesonide-formoterol inhaler use vs inhaled epinephrine use in adults with mild asthma from a US societal perspective over a lifetime horizon, with a 3% annual discount rate (2022 US dollars). Inputs were derived from the SYmbicort Given as-needed in Mild Asthma (SYGMA) trials, published literature, and commercial costs. Outcomes were quality-adjusted life-years (QALY), costs, incremental net monetary benefit (INMB), severe asthma exacerbations, well-controlled asthma days, and asthma-related deaths. Microsimulation was used to evaluate underinsured Americans living with mild asthma (n = 5,250,000). Results: Inhaled epinephrine was dominated (with lower QALYs gains at a higher cost) by both as-needed budesonide-formoterol (INMB, $15,541 at a willingness-to-pay of $100,000 per QALY) and the no-OTC inhaler option (INMB, $1023). Adults using as-needed budesonide-formoterol had 145 more well-controlled asthma days, 2.79 fewer severe exacerbations, and an absolute risk reduction of 0.23% for asthma-related death compared with inhaled epinephrine over a patient lifetime. As-needed budesonide-formoterol remained dominant in all sensitivity and scenario analyses, with a 100% probability of being cost-effective compared with inhaled epinephrine in probabilistic sensitivity analysis. Conclusion: If made available, OTC as-needed budesonide-formoterol for treating mild asthma in underinsured adults without HCP management improves asthma outcomes, prevents fatalities, and is cost-saving. Competing Interests: Disclosures Dr Shaker has participated in research that has received funding from DBV; is a member of the Joint Task Force on Practice Parameters; serves as an associated editor for Annals of Allergy, Asthma, and Immunology; and is an editorial board member for the Journal of Allergy and Clinical Immunology In Practice. Dr Greenhawt is a consultant for Aquestive; is a member of physician and medical advisory boards for DBV Technologies, Nutricia, Novartis, Aquestive, Allergy Therapeutics, AstraZeneca, ALK-Abello, Bryn, and Prota; is an unpaid member of the scientific advisory council for the National Peanut Board and the medical advisory board of the International Food Protein Induced Enterocolitis Syndrome Association; is a member of the Brighton Collaboration Criteria Vaccine Anaphylaxis 2.0 working group; is the senior associate editor for the Annals of Allergy, Asthma, and Immunology, and is member of the Joint Taskforce on Allergy Practice Parameters. Dr Sadatsafavi has received honoraria from GlaxoSmithKline and AstraZeneca for unrelated activities; and received funding from AstraZeneca and GlaxoSmithKline for unrelated projects. Dr Abrams is an employee of the Public Health Agency of Canada. Dr Oppenheimer is a consultant for Amgen, Aimmune, Aquestive, GSK, and Sanofi; is a member of the Adjudication or Data Safety Monitoring Board for AstraZeneca, Amgen, Abbvie, Novartis, and GlaxoSmithKline; is the Executive Editor for the Annals of Allergy Asthma and Immunology; and is a reviewer for UpToDate. Dr Mosnaim receives current research grant support from GlaxoSmithKline, Novartis, and Sanofi-Regeneron; and has received past research grant support from AstraZeneca, ALK-Abello, Teva, and Genentech. The remaining authors have no conflicts of interest to report. (Copyright © 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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