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

Guido van den Boom, Maureen P.M.H. Rutten-Van Mölken*, Johan Molema, Prasanna R.S. Tirimanna, Chris Van Weel, Constant P. Van Schayck

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

51 Citations (Scopus)

Abstract

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 μg twice a day or placebo twice a day via pMDl in a 1-yr, double-blind trial if they met criteria for persistent airway obstruction, increased bronchial hyperresponsiveness, or a rapid decline in FEV1. Main outcome measures were postbronchodilator FEV1, quality-adjusted life years (QALYs), and direct medical cost. Secondary measures were prebronchodilator FEV1, PC20, 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 FEV1 (98 ml/yr; p = 0.01) in favor of fluticasone. Only subjects with reversible obstruction showed an improvement in PC20 (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.

Original languageEnglish
Pages (from-to)2057-2066
Number of pages10
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume164
Issue number11
DOIs
Publication statusPublished - 1 Dec 2001

Bibliographical note

Supported by The Dutch Prevention Fund, The Netherlands Organisation for Scientific Research, The Dutch Asthma Foundation, and Glaxo-Wellcome B.V.

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