哮喘联盟

   摘要
   简介：在英国国家医疗服务体系(NHS)中，哮喘的经济负担是过敏性疾病中最大的。目前的哮喘指南建议正接受吸入糖皮质激素(ICS)单药疗法和未控制的哮喘患者应在低剂量吸入糖皮质激素(ICS)的同时增加长效β2受体激动剂(LABA)。使用压力定量吸入器(pMDI)的丙酸氟替卡松和昔萘酸沙美特罗的固定剂量复方制剂(FP/FORM)是最常用的ICS/LABA复方制剂处方。另外，目前也可使用pMDI丙酸氟替卡松和富马酸福莫特罗的固定剂量复方制剂(FP/FORM)。在为期12周的非劣效性研究中，已证明FP/FORM与FP/SAL的疗效相当。本研究旨在评价UK NHS使用FP/FORM替代FP/SAL后对年度预算影响。
   方法：目前的pMDI处方数据来自于真实的英国病人数据库(Cegedim 策略数据)。评估NHS使用FP/FORM 和 FP/SAL因药物收购、管理和监控的年成本，并用于评价NHS使用FP/FORM替代FP/SAL后潜在的预算影响。依据方案分析评估摄入、依从性、不良事件相关花费以及资源利用的不同比率与转换治疗的相关性。
   结果：假设两种方案使用相同水平的ICS，使用FP/FORM (£412)的每人年度药物购置成本低于FP/SAL (£509)。假设摄入FP/FORM超过FP/SAL现有患者的50%，治疗组间购置成本和其他可比的投入成本的差额，可使NHS每年节省£15,110,279。在所有方案分析评估中，FP/FORM的采用可为NHS节约成本。
   结论：FP/FORM 与FP/SAL相比，疗效相当且具有更低的购置成本，使得其成为UK NHS为需使用pMDI联合维持治疗的哮喘患者节约成本的选择。

（林江涛 审校）
Adv Ther. 2013 Nov 6. [Epub ahead of print]

 

Budget Impact Analysis of a Fixed-Dose Combination of Fluticasone Propionate and Formoterol Fumarate (FP/FORM) in a Pressurized Metered-Dose Inhaler (pMDI) for Asthma.
 

Dunlop W, Heron L, Fox G, Greaney M.
 

Abstract
INTRODUCTION: The economic burden of asthma on the UK National Health Service (NHS) is the largest among allergic diseases. Current asthma guidelines recommend adding a long acting β2-agonist (LABA) to a low-dose inhaled corticosteroid (ICS) in patients who are on ICS monotherapy and have uncontrolled asthma. The fixed-dose combination of fluticasone propionate and salmeterol xinafoate (FP/SAL), available in a pressurized metered-dose inhaler (pMDI) device, is the most commonly prescribed ICS/LABA combination. An additional fixed-dose combination of fluticasone propionate and formoterol fumarate (FP/FORM) in pMDI is now available. In a 12-week non-inferiority study, FP/FORM demonstrated comparable efficacy to FP/SAL. The present analysis estimates the annual budget impact for the UK NHS using FP/FORM as an alternative to FP/SAL.
METHODS: Current pMDI prescribing data were from a real-world UK patient database (Cegedim Strategic Data). Annual costs to the NHS for drug acquisition, administration, and monitoring were estimated for FP/FORM and FP/SAL and used to  assess the potential budget impact for the NHS for the use of FP/FORM instead of  FP/SAL. Varying rates of uptake, adherence, adverse event-related costs, and resource use associated with switching treatment were assessed in scenario analyses.
RESULTS: Assuming similar levels of ICS use with both regimens, annual drug acquisition costs per person were lower with FP/FORM (£412) than with FP/SAL (£509). The difference in acquisition costs and otherwise comparable input costs  between the treatments, results in potential annual savings of £15,110,279 to the NHS, assuming uptake of FP/FORM over FP/SAL in 50% of existing patients. The introduction of FP/FORM results in cost savings for the NHS in all of the assessed scenario analyses.
CONCLUSIONS: The comparable efficacy and lower acquisition costs of FP/FORM compared with FP/SAL make it a cost-saving option for the UK NHS for the treatment of asthma patients requiring combination maintenance therapy using a pMDI.
 

Adv Ther. 2013 Nov 6. [Epub ahead of print]