Cost-Effectiveness Analysis of Inhaled Corticosteroids for Mild and Moderate Asthma in Thai Health Care Context

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Chulapom Limwattananon
Duangkamon Saklertsakoon
Panamas Pumas
Supon Limwattananon


Asthma is a common chronic disease with an estimated prevalence of 10-13% of children and 5-9% of adult population in Thailand. Asthma places an economic burden to health care system due to high rates of emergency visits and hospitalization. Currently, the Thai Thoracic Physician Association recommends the use of inhaled corticosteroids (ICS) according to GINA guideline for patients with persistent asthma of all stages. However, ICS has been underutilized in most medical practice because of its relatively expensive cost. This study aims to determine an incremental cost-effectiveness ratio (ICER) of ICS used with short acting beta-2 agonists, compared with the beta-2 agonists alone in patients with mild and moderate asthma, aged 18-35 and over 35 years who had or had no prior hospitalization, using health care provider perspective Effectiveness and quality of life data were obtained from Asthma Policy Model used in the us. Cost data were abstracted from electronic databases in 18 provincial hospitals. Markov Model with one-month cycle was used for data analysis. Over a 10-year period, ICER of ICS for a group of patients with mild asthma, no prior hospitalization, and age 18-35 years was Baht -2,636 per quality-adjusted life month (QALM). For a group of moderate asthma with more than one prior hospitalization and age over 35 years, ICER decreased to Baht -15,602 per QALM. For the 5-year time frame, ICER per QALM for the two groups increased to Baht 1,340 and -9,423, respectively. For 3 years of drug use, ICER increased to Baht 3,255 and -4,743, respectively. In conclusion, ICS is considered the cost-effective treatment for asthma in Thai health care context.


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Bisgaard H., Price M.J., Maden c., Olsen N.A. (2001). Cost-effectiveness of fluticasone propionate administered via metered dose inhaler plus baby inhaler spacer in the treatment of asthma in preschool aged children. Chest. 120: 1835-1842.
Blais. L., Ernst P., Boivin J.F., Suissa S. (1998). Inhaled corticosteroids and the prevention of readmission to hospital for asthma. Am. J. Respir. Crit. Care Med. 158:, .126-132.
Boonsawat W., Charoenphan P. (2002). Survey of asthma control in Thailand. Joint Scientific Meeting of the Thoracic Society of Thailand, the Malaysian Thoracic Society, and the Singapore Thoracic Society. Bangkok, Thailand.
Briggs A., Sculpher M. (1998). An introduction to Markov modeling for economic evaluation. Pharmacoeconomics. 13(4): 397-409.
Limwattananon C., Limwattanannon S., Pannarunothai S. (2004). Accessibility to inhaled corticosteroids in adults with chronic asthma: impact of the Universal Health Care Coverage Policy. Proceedings of the second International Conference on Improving Use of Medicine, Chiang Mai 30 Mar-2 Apr.
Lundback B, Jenkins C., Price M.J., Thwaites R.M. (2000). Cost-effectiveness of salmeterol/ fluticasone proprionate combination product 50/ 250 microgram twice daily and budesonide 800 microgram twice daily in the treatment of adults and adolescents with asthma. Rcspir. Med. 94: 724-732.
Menndenz R., Stanford R.H., Edwards L., Kalberg C., Rickard K. (2001). Cost-efficacy analysis of fluticasone propionate versus zafirlukast in patients with persistent asthma. Pharmacoeconomics. 19: 865-874.
National Heart Lung and Blood Institute/National Institutes of Health. (2002). Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention. Global Strategy for Asthma Management and Prevention NHLBI/WHO Workshop. NIH Publication No. 02-3659. Bethesda. MD.
Paltiel A.D., Fuhlbrigge A.L., Kitch B.T., Liljas B., Weiss S.T., Neumann P.J. (2001i). Cost-effectiveness of inhaled corticosteroids in adults with mild-to-moderate asthma: Results from the Asthma Policy Model. J. Allergy Clin. Immunol. 108 : 39-46.
Perera B.J. (1995) Efficacy and cost effectiveness of inhaled steroid in asthma in a developing country. Arch. Dis. Child. 72: 312-315.
TreeAge Software. DATA for Health Care version 3.5, MA.
Vichyanond (1998). Prevalence of asthma, rhinitis, and eczema in children from the Bangkok area using the ISAAC (International Study for Asthma and Allergy in Children) Questionnaires. J. Med. Assoc. Thai. 81: 175-184.
Volmer. T., Kielhorn A., Weber H.H., Wiessmann K.J. (1999). Cost-effectiveness of fluticasone proprionate and flunisoiide in the treatment of corticosteroid-native patients with moderate asthma. Pharmacoeconomics. 16: 525-531.