Late Breaking Abstract - Cost effectiveness of as-needed budesonide/formoterol vs low-dose ICS maintenance therapy in mild asthma patients: A UK perspective

Objective: To estimate the cost-effectiveness of as-needed budesonide/formoterol (BUD/F; Symbicort® Turbuhaler®) vs daily low-dose inhaled budesonide (BUD) + short-acting ß2-agonist (SABA) as reliever in mild asthma patients for whom low-dose ICS maintenance therapy is appropriate. Methods: This analysis was based on SYGMA 2 (NCT02224157), a 52-week, double-blind trial of patients aged ≥12 years with mild asthma, using a Markov model (weekly cycles) and a UK healthcare (lifetime) perspective. Comparisons were as-needed BUD/F 200/6µg or BUD 200µg twice daily (bid) + terbutaline 0.5mg as needed. Health states in the model were exacerbation (≥3 days of oral steroid alone or combined with hospitalisation and/or ER visit), death and non-exacerbation. Quality adjusted life years (QALY) gained was based on EQ-5D-5L (mapped to 3L). Extrapolation was based on UK published literature and cost estimates were based on NHS unit cost values (£). Probabilistic results are presented to control for parameter uncertainty. Results: Over a patient’s lifetime, as-needed BUD/F was dominant with a small cost saving of £290/patient and marginal QALY gains of 0.0011; key drivers were lower total medication cost (0.52 vs. 2 inhalations/day) and lower exacerbation rate (0.11 vs 0.12) with as-needed BUD/F vs daily BUD, respectively. Cost-effectiveness acceptability curve showed that, across a wide range of willingness to pay for QALY (including £20,000/QALY threshold), likelihood of as-needed BUD/F being cost-effective vs daily BUD therapy + SABA was >90%. Conclusion: From a UK perspective, as-needed BUD/F offers an economic benefit for the treatment of patients with mild asthma.