Am. J. Respir. Crit. Care Med., Volume 164, Number 11, December 2001, 2057-2066

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, and CONSTANT P. VAN SCHAYCK

Department of General Practice and Social Medicine, University of Nijmegen, Nijmegen, Institute for Medical Technology Assessment, Erasmus University of Rotterdam, Rotterdam, and Department of Pulmonology, University of Nijmegen, Nijmegen, The Netherlands

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 pMDI 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.

This article has been cited by other articles:

				M. Albers, T. Schermer, J. Molema, C. Kloek, R. Akkermans, Y. Heijdra, and C. van Weel Do family physicians' records fit guideline diagnosed COPD? Fam. Pract., April 1, 2009; 26(2): 81 - 87. [Abstract] [Full Text] [PDF]

				M Albers, T Schermer, Y Heijdra, J Molema, R Akkermans, and C van Weel Predictive value of lung function below the normal range and respiratory symptoms for progression of chronic obstructive pulmonary disease Thorax, March 1, 2008; 63(3): 201 - 207. [Abstract] [Full Text] [PDF]

				M. Cazzola, W. MacNee, F. J. Martinez, K. F. Rabe, L. G. Franciosi, P. J. Barnes, V. Brusasco, P. S. Burge, P. M. A. Calverley, B. R. Celli, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers Eur. Respir. J., February 1, 2008; 31(2): 416 - 469. [Abstract] [Full Text] [PDF]

				M. P.M.H. Rutten-van Molken, J. B. Oostenbrink, D. P. Tashkin, D. Burkhart, and B. U. Monz Does Quality of Life of COPD Patients as Measured by the Generic EuroQol Five-Dimension Questionnaire Differentiate Between COPD Severity Stages? Chest, October 1, 2006; 130(4): 1117 - 1128. [Abstract] [Full Text] [PDF]

				G. Xie, Y. Li, P. Shi, B. Zhou, P. Zhang, and Y. Wu Baseline Pulmonary Function and Quality of Life 9 Years Later in a Middle-Aged Chinese Population Chest, October 1, 2005; 128(4): 2448 - 2457. [Abstract] [Full Text] [PDF]

				H. J. Schunemann, R. Goldstein, M. J. Mador, D. McKim, E. Stahl, M. Puhan, L. E. Griffith, B. Grant, P. Austin, R. Collins, et al. A randomised trial to evaluate the self-administered standardised chronic respiratory questionnaire Eur. Respir. J., January 1, 2005; 25(1): 31 - 40. [Abstract] [Full Text] [PDF]

				M. Albers, T. Schermer, G. van den Boom, R. Akkermans, C. van Schayck, C. van Herwaarden, and C. van Weel Efficacy of Inhaled Steroids in Undiagnosed Subjects at High Risk for COPD: Results of the Detection, Intervention, and Monitoring of COPD and Asthma Program Chest, December 1, 2004; 126(6): 1815 - 1824. [Abstract] [Full Text] [PDF]

				D. A. Mahler, S. Huang, M. Tabrizi, and G. M. Bell Efficacy and Safety of a Monoclonal Antibody Recognizing Interleukin-8 in COPD: A Pilot Study Chest, September 1, 2004; 126(3): 926 - 934. [Abstract] [Full Text] [PDF]

				M. Cazzola and R. Dahl Inhaled Combination Therapy With Long-Acting {beta}2-Agonists and Corticosteroids in Stable COPD Chest, July 1, 2004; 126(1): 220 - 237. [Abstract] [Full Text] [PDF]

				H. J. Schunemann, L. Griffith, R. Jaeschke, R. Goldstein, D. Stubbing, P. Austin, and G. H. Guyatt A Comparison of the Original Chronic Respiratory Questionnaire With a Standardized Version Chest, October 1, 2003; 124(4): 1421 - 1429. [Abstract] [Full Text] [PDF]

				C.P. van Schayck and N.H. Chavannes Detection of asthma and chronic obstructive pulmonary disease in primary care Eur. Respir. J., January 1, 2003; 21(39_suppl): 16S - 22s. [Abstract] [Full Text] [PDF]

				C P van Schayck, J M C Loozen, E Wagena, R P Akkermans, and G J Wesseling Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study BMJ, June 8, 2002; 324(7350): 1370 - 1370. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 642 - 662. [Full Text] [PDF]