Abstract
Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs.
The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs.
Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD 433.70 (AUD 48.59–818.81) or EUR 260.22 (EUR 29.15–491.29)), unplanned healthcare visits (AUD 20.25 (AUD 5.23–35.27) or EUR 12.15 (EUR 3.14–21.16)), antibiotic costs (AUD 14.88 (AUD 7.55–22.21) or EUR 8.93 (EUR 4.53–13.33)) and oral corticosteroid costs (AUD 4.73 (AUD 0.82–8.64) or EUR 2.84 (EUR 0.49–5.18)); all p<0.05. Overall healthcare and societal costs were lower (AUD 77.30 (EUR 46.38) and AUD 256.22 (EUR 153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD 2072.30 (95% CI AUD 1348.55–2805.23) or (EUR 1243.38 (EUR 809.13–1683.14) assuming a willingness to pay per exacerbation avoided of AUD 2651 (EUR 1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant.
Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.
Abstract
Add-on AZM in the treatment of poorly controlled persistent asthma is cost-effective. It is associated with a positive net monetary benefit when costs including those associated with antimicrobial resistance are considered. https://bit.ly/31aZ3fi
Footnotes
This article has supplementary material available from erj.ersjournals.com
This study is registered at the Australian and New Zealand Clinical Trials Registry (ANZCTR), number 12609000197235.
Conflict of interest: C. O'Neill reports grants for education activities from Roche, AbbVie, Novartis and Pfizer, outside the submitted work.
Conflict of interest: P.G. Gibson reports personal fees for lectures from AstraZeneca, GlaxoSmithKline and Novartis, grants from AstraZeneca and GlaxoSmithKline, outside the submitted work.
Conflict of interest: L.G. Heaney reports sponsorship for meeting attendance from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Napp Pharmaceutical, personal fees for advisory board work and lectures from Novartis, Hoffman la Roche/Genentech Inc, Sanofi, GlaxoSmithKline, AstraZeneca, Teva, Theravance and Circassia, grants from Medimmune, Novartis UK, Roche/Genentech Inc. and GlaxoSmithKline, and Amgen, outside the submitted work; and is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves industrial partnerships with Genentech/Hoffman la Roche, AstraZeneca, Medimmune, GlaxoSmithKline, Aerocrine and Vitalograph.
Conflict of interest: J.W. Upham reports grants from NHMRC, during the conduct of the study.
Conflict of interest: I.A. Yang reports grants from NHMRC, during the conduct of the study.
Conflict of interest: P.N. Reynolds reports grants from NHMRC, during the conduct of the study.
Conflict of interest: S. Hodge reports grants from NHMRC, during the conduct of the study.
Conflict of interest: C.R. Jenkins reports grants from NHMRC, during the conduct of the study.
Conflict of interest: M. Peters reports grants from NHMRC, during the conduct of the study.
Conflict of interest: G.B. Marks reports grants from NHMRC, during the conduct of the study; grants and advisory board work from AstraZeneca, grants from GSK, outside the submitted work.
Conflict of interest: A.L. James reports grants from NHMRC, during the conduct of the study.
Conflict of interest: J.L. Simpson reports grants from NHMRC, during the conduct of the study.
Support statement: This work was supported by the National Health and Medical Research Council. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received June 21, 2020.
- Accepted August 13, 2020.
- Copyright ©ERS 2021
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