The cost effectiveness of early treatment with fluticasone propionate 250 microg twice a day in subjects with obstructive airway disease. Results of the DIMCA program

• Published in: American journal of respiratory and critical care medicine Vol. 164; no. 11; p. 2057
• Main Authors: van den Boom, G, Rutten-van Mölken, M P, Molema, J, Tirimanna, P R, van Weel, C, van Schayck, C P
• Format: Journal Article
• Language: English
• Published: United States 01.12.2001
• Subjects: Absenteeism; Activities of Daily Living; Androstadienes - economics; Androstadienes - pharmacology; Androstadienes - therapeutic use; Anti-Asthmatic Agents - economics; Anti-Asthmatic Agents - pharmacology; Anti-Asthmatic Agents - therapeutic use; Anti-Inflammatory Agents - economics; Anti-Inflammatory Agents - pharmacology; Anti-Inflammatory Agents - therapeutic use; Bronchial Hyperreactivity - drug therapy; Bronchial Hyperreactivity - physiopathology; Bronchial Hyperreactivity - psychology; Cost-Benefit Analysis; Direct Service Costs - statistics & numerical data; Double-Blind Method; Drug Administration Schedule; Drug Costs - statistics & numerical data; Female; Fluticasone; Forced Expiratory Volume - drug effects; Health Status; Humans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Quality of Life; Quality-Adjusted Life Years; Recurrence; Time Factors; Treatment Outcome
• ISSN: 1073-449X
• DOI: 10.1164/ajrccm.164.11.2003151

In a two-stage detection program, subjects with signs of obstructive airway disease were selected from a random sample of the general population. Subjects (n = 82) were randomly assigned to either fluticasone propionate 250 microg twice a day or placebo twice a day via pMDI in a 1-yr, double-blind trial if they met criteria for persistent airway obstruction, increased bronchial hyperresponsiveness, or a rapid decline in FEV(1). Main outcome measures were postbronchodilator FEV(1), quality-adjusted life years (QALYs), and direct medical cost. Secondary measures were prebronchodilator FEV(1), PC(20), health-related quality of life (CRQ), symptom-free weeks, episode-free weeks, exacerbations, and indirect cost. Subgroup analysis was based on reversibility of obstruction. Analysis revealed a significant gain in postbronchodilator FEV(1) (98 ml/yr; p = 0.01) in favor of fluticasone. Only subjects with reversible obstruction showed an improvement in PC(20) (1.4 doubling dose; p = 0.03). Early treatment resulted in 2.7 QALYs gained per 100 treated subjects (p = 0.17) and in a clinically relevant improvement in dyspnea (CRQ; p < 0.03). The incremental cost effectiveness ratios were US$13,016/QALY for early treatment and US$33,921/QALY for the combination of detection and treatment. The incremental cost for one additional subject with a clinically relevant difference in dyspnea was US$1,674. In conclusion, early intervention with fluticasone resulted in significant health gains at relatively low financial cost.