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Cost-Effectiveness of Fluticasone Propionate Administered Via Metered-Dose Inhaler Plus Babyhaler^TM Spacer in the Treatment of Asthma in Preschool-Aged Children^*

^* From the Copenhagen University Hospital (Dr. Bisgaard), Rigshospitalet, Copenhagen, Denmark; Global Health Outcomes (Dr. Price), Glaxo Wellcome Research and Development, Middlesex, UK; Respiratory Therapeutic Development (Ms. Maden), Glaxo Wellcome Research and Development, Uxbridge, UK; and Glaxo Wellcome (Mr. Olsen), Brondby, Denmark.

Correspondence to: Hans Bisgaard, MD, Professor of Paediatrics, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; e-mail: Bisgaard{at}copsac.dk

Study objectives: To evaluate the cost-effectiveness of inhaled fluticasone propionate (FP) in children aged 12 to 47 months with asthma symptoms.

Design: A retrospective economic analysis conducted from the perspective of the Danish health-care system, based on clinical data from a 12-week study.

Setting: Thirty-three outpatient centers in nine countries.

Patients: Two hundred thirty-seven children aged 12 to 47 months with documented history of recurrent wheeze or asthma symptoms.

Interventions: Two dosages of FP, 100 µg/d and 200 µg/d, and placebo administered in two divided doses via a metered-dose inhaler and a Babyhaler (Glaxo Wellcome; Middlesex, UK) spacer device.

Measurements: Effectiveness in terms of asthma exacerbations, control of cough and wheeze symptoms, symptom-free days, overall direct costs of asthma management in Danish kroner at 1999 prices, and mean and incremental cost-effectiveness ratios.

Results: FP, 200 µg/d, was significantly more effective than placebo treatment in terms of the proportion of exacerbation-free patients (73.7% vs 59.8%; p = 0.025) and patients experiencing a 25% improvement in cough symptoms (57.9% vs 39.0%; p = 0.018). The costs per exacerbation-free patient, per patient with a 25% improvement in cough and wheeze symptoms from baseline, and per symptom-free day were lower in the FP groups than in the placebo group. The incremental cost-effectiveness ratios for these end points indicated that the additional benefits of FP, 200 µg/d, were achieved at a lower overall cost compared with placebo treatment.

Conclusions: From the perspective of the Danish health-care system, FP, 100 µg bid, administered via the Babyhaler inhalation device was cost-effective relative to standard therapy with bronchodilators alone.

Key Words: asthma • cost effectiveness • fluticasone propionate • preschool children

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