Real-World Cost Effectiveness Comparison Of Symbicort Turbuhaler And Duoresp Spiromax In UK Patients With Asthma Or Chronic Obstructive Pulmonary Disease

Objectives: To compare economic outcomes between patients with asthma or chronic obstructive pulmonary disease (COPD) receiving continuous maintenance inhaled corticosteroid/long-acting beta agonist (ICS/LABA) treatment with Symbicort and those switching from Symbicort to DuoResp. Methods: This was a historical cohort study using anonymised data from two UK primary care databases, the Optimum Patient Care Research Database and the Clinical Practice Research Datalink. Included patients had ≥ 2 years of continuous data (1-year baseline pre- and 1-year outcome post-index date). Patients switching to DuoResp were matched (1:3) with those continuing on Symbicort. Mean asthma/ COPD-related healthcare costs (medication, primary care and hospital visits) were calculated in 2014 £ and compared between groups, adjusting for confounders. Risk domain control of disease (RDC), a composite measure defining absence of exacerbations, adjusted for rhinitis, was used to assess disease control. Costeffectiveness was assessed based on total treatment costs and the absolute proportion of patients achieving RDC. Results: Patients who switched to DuoResp had lower baseline respiratory-related costs than the Symbicort group when ICS costs were included (p= 0.036). In the outcome year, switching to DuoResp was associated with significantly lower mean costs per patient in total respiratory medication (-£80; p<0.001), primary care consultations (-£13; p<0.001) and total respiratory-related costs including ICS (-£92; p<0.001). The adjusted proportion of patients achieving RDC was 58% for DuoResp versus 54% for Symbicort. Adjusted mean cost was £492 (95% CI: £461, £523) for DuoResp users and £597 (£575, £620) for Symbicort users, for a difference of -£105 (-£132, -£78) after adjusting for all baseline costs. Bootstrap sensitivity analysis found DuoResp to be less costly and more effective than Symbicort with 93.7% consistency. Conclusions: Compared with patients with asthma or COPD continuing Symbicort treatment, those switching to DuoResp demonstrated a favourable cost-effectiveness ratio in the UK primary care setting.