Cost effectiveness of inhaled steroid withdrawal in outpatients with chronic obstructive pulmonary disease

van der Palen, J.; Monninkhof, E.; van der Valk, P.; Sullivan, S. D.; Veenstra, D. L.
January 2006
Thorax;Jan2006, Vol. 61 Issue 1, p29
Academic Journal
Background: The evidence for the effectiveness and safety of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) is inconclusive. This study determined the cost effectiveness of withdrawing fluticasone propionate (FP) in outpatients with COPD. Methods: The cost effectiveness analysis was based on a randomised, placebo controlled FP withdrawal study. After a 4 month run in period on FP, patients were randomly assigned to continue FP 500 μg twice daily or to receive placebo for 6 months. A decision analytical model evaluated the 6 month incremental cost effectiveness of the ICS versus ICS withdrawal strategy. One way sensitivity analyses and a Monte Carlo simulation were performed to evaluate the robustness of the findings. Results: The average patient with COPD in the FP group generated €511 in direct medical costs, including €238 for FP. The cost of the placebo strategy was €456. The higher direct drug cost of €212 per patient for the FP strategy during the 6 month follow up period compared with the placebo group was partially offset by a lower exacerbation and hospital admission cost of €157. The 6 month incremental cost effectiveness of the FP strategy compared with placebo was €110 per exacerbation prevented and €1286 per hospital admission prevented. Conclusions: Over a 6 month period, withdrawing FP in a pre-selected trial population of COPD patients led to absolute cost savings but with a higher rate of exacerbations and hospital admissions.


Related Articles

  • Inhaled cortico-steroids and COPD exacerbations.  // Infectious Disease Alert;Apr2010 Primary Care, p8 

    The article discusses research done by R. Agarwal and colleagues on inhaled corticosteroids versus placebo for preventing chronic obstructive pulmonary disease (COPD) exacerbations, published in a 2010 issue of "Chest."

  • Inhaled corticosteroids and COPD exacerbations. Kuritzky, Louis // Neurology Alert;Apr2010 Pharmacology, p8 

    The article discusses research on using placebo and inhaled corticosteroids (ICS) for the prevention of chronic obstructive pulmonary disorder (COPD) exacerbations, concluding that there is an increased risk of pneumonia among patients with COPD who were given ICS.

  • Mild persistent asthma and inhaled corticosteroids: is daily therapy really necessary? Bauchner, Howard // Archives of Disease in Childhood;Oct2005, Vol. 90 Issue 10, p1094 

    This article cites a study on the treatment of mild persistent asthma, which was published in the May 6, 2005 issue of the "Journal Watch Pediatrics and Adolescent Medicine." In this double-blind trial, researchers randomized 225 adults with mild persistent asthma to receive twice-daily inhaled...

  • Inhaled corticosteroids and COPD exacerbations.  // Clinical Cardiology Alert;Apr2010 Primary Care Supplement, Vol. 15 Issue 4, p8 

    The article discusses research on the effectiveness of inhaled corticosteriods compared with placebo in preventing chronic obstructive pulmonary disease (COPD) exacerbations by R. Agarwal and colleagues published in a 2010 issue of "Chest."

  • Which Inhaler Combination is Best for COPD Treatment? Elliott, William T. // Clinical Oncology Alert;Apr2007 Pharmacology Watch, p1 

    The article discusses two studies which have looked at the effects of various inhaler combinations on outcomes in patients with chronic obstructive pulmonary disease (COPD). According to a study that was published in the February 22, 2007 issue of "New England Journal of Medicine," the mortality...

  • Combination therapy 'best for COPD patients'. Polak, Monika // GP: General Practitioner;12/1/2003, p13 

    Combination therapy may be the best option for patients who have severe COPD, according to a Great Britain-led study. The results showed that the time to the first exacerbation among patients who were treated with an inhaled corticosteroid in combination with a long-acting beta-2 agonist was...

  • Analysis. Summerton, Nick // Update;5/19/2005, Vol. 70 Issue 5, p26 

    This article presents a study to find out whether intermittent as-needed corticosteroid treatment for mild persistent asthma equivalent to regular daily treatment. Treatment with daily or intermittent corticosteroid therapy in a six-centre randomised controlled trial was conducted. After...

  • Comparison of the systemic effects of fluticasone propionate and budesonide given by dry powder inhaler in healthy and asthmatic subjects. Harrison, T. W.; Wisniewski, A.; Honour, J.; Tattersfield, A. B. // Thorax;Mar2001, Vol. 56 Issue 3, p186 

    Background-The potential for long term adverse effects from inhaled corticosteroids relates to their systemic absorption, usually assessed from proxy markers in short term studies. When fiuticasone propionate and budesonide have been compared in this way the results have been inconsistent. To...

  • Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of administrative claims data. Mapel, Douglas W.; Dutro, Michael P.; Marton, Jenõ P.; Woodruff, Kimberly; Make, Barry // BMC Health Services Research;2011, Vol. 11 Issue 1, p43 

    Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death among US adults and is projected to be the third by 2020. In anticipation of the increasing burden imposed on healthcare systems and payers by patients with COPD, a means of identifying COPD patients...


Read the Article


Sign out of this library

Other Topics