Real-world Effectiveness and Cost-effectiveness of Leading Inhaled Corticosteroids in Asthma Management
Condition: Asthma
MeSH terms: Asthma
Study type: Observational

Summary: 
      The objective of the study was to compare the effectiveness, cost-effectiveness and direct
      healthcare costs of managing asthma in patients with evidence of persistent asthma, following
      the initiation and increased dose of inhaled corticosteroid (ICS) therapy using HFA-BDP
      (Qvar®) (either as initial therapy or as a step-up therapy) compared with the most commonly
      prescribed alternative ICS in the UK, CFC-beclometasone (BDP) and fluticasone (FP) as metered
      dose inhalers (MDIs). Qvar vs FP analyses were split between adults (12-60yrs) and
      paediatrics (5-11yrs).
    

Detailed description: 
      While current UK asthma guidelines are underpinned with evidence from RCTs, much of this
      evidence has been undertaken in patients who are not representative of the majority of the
      current UK asthma population. In fact it has been estimated that fewer than 10% of the
      patients seen in everyday clinical practice would be eligible for inclusion in such trials.
      The poor representation of the asthma population is due to a number of factors, such as
      tightly-controlled inclusion criteria for RCTs. There is therefore a need for more
      representative RCTs and real-life and observational studies to inform existing guidelines and
      help optimise asthma outcomes. A more holistic approach to respiratory research would see RCT
      evidence complimented by "real-life" data from pragmatic trials and observational studies.

      A number of trends are emerged in asthma prescribing that warrant further investigation to
      ascertain their benefit to both the patient and the NHS. In particular, significant pressure
      exists to use the cheapest inhaler devices and formulations. An analysis of a pragmatic trial
      of Qvar versus standard CFC-BDP undertaken by Research in Real Life suggested that Qvar may
      be offer greater effectiveness in.5,6 In light of these data, the following report details
      the findings of a study designed to examine the effectiveness of Qvar in real-life clinical
      practice using the General Practice Research Database (GPRD).
    

Intervention name(s): Extra-fine hydrofluoroalkane-beclomethasone dipropionate; Extra-fine hydrofluoroalkane-beclomethasone dipropionate; Fluticasone propionate; Beclomethasone dipropionate; fluticasone propionate; Chlorofluorocarbon beclomethasone dipropionate
Intervention type(s): Drug; Drug; Drug; Drug; Drug; Drug
Intervention description(s): Initiation of HFA-BDP (any dose) in steroid naive patients via MDI; An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as HFA-BDP via MDI; An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as FP via MDI; An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as CFC-BDP via MDI; Initiation of FP (any dose) via MDI in steroid naive patient; Initiation of CFC-BDP (any dose) via MDI in steroid naive patient
Other intervention name(s): Qvar®; Qvar
Intervention MeSH terms: Fluticasone; Xhance; Beclomethasone
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Primary care asthma patients receiving who either initiated ICS therapy as any of extrafine
        HFA-BDP, CFC-BDP of FP via MDI at an index prescription date (IPD), or were on existing ICs
        therapy (any) and had an increase in ICS dose at IPD as any of extrafine HFA-BDP, CFC-BDP
        of FP via MDI
      
Keywords: Primary care; Asthma management; Inhaled corticosteroids; Beclomethasone dipropionate; Fluticasone propionate; Metred dose inhaler; Extra-fine hydrofluoroalkane; Chlorofluorocarbon