PT  - JOURNAL ARTICLE
AU  - Ciaran O'Neill
AU  - Peter G Gibson
AU  - Liam G Heaney
AU  - John W Upham
AU  - Ian A Yang
AU  - Paul N Reynolds
AU  - Sandra Hodge
AU  - Christine R Jenkins
AU  - Matthew Peters
AU  - Guy B Marks
AU  - Alan L James
AU  - Jodie L Simpson
TI  - The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma
AID  - 10.1183/13993003.02436-2020
DP  - 2020 Jan 01
TA  - European Respiratory Journal
PG  - 2002436
4099  - http://erj.ersjournals.com/content/early/2020/08/18/13993003.02436-2020.short
4100  - http://erj.ersjournals.com/content/early/2020/08/18/13993003.02436-2020.full
AB  - 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 ($48.59–$818.81) or €260.22(€29.15–€491.29)), unplanned healthcare visits (AUD$20.25 ($5.23–$35.27) or €12.15 (€3.14–€21.16)), antibiotic costs (AUD$14.88 ($7.55–$22.21) or €8.93(€4.53–€13.33)) and oral corticosteroid costs (AUD$4.73 ($0.82–$8.64) or €2.84(€0.49–€5.18)), all p<0.05. Overall healthcare and societal costs were lower (AUD$77.30 (€46.38) and AUD$256.22 (€153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD$2072.30 (95% CI $1348.55–$2805.23) or (€1243.38 (€809.13–€1683.14) assuming a willingness to pay per exacerbation avoided of AUD$2651 (€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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. O'Neill reports grants from Roche, grants from AbbVie, grants from Novartis, grants from Pfizer, outside the submitted work;.Conflict of interest: Dr. Gibson reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work;.Conflict of interest: Dr. Heaney reports other from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceutical, personal fees from Novartis, Hoffman la Roche/Genentech Inc, Sanofi, Glaxo Smith Kline, Astra Zeneca, Teva, Theravance, Circassia, grants from Medimmune, Novartis UK, Roche/Genentech Inc, and Glaxo Smith Kline, Amgen, Genentech / Hoffman la Roche, Astra Zeneca, Medimmune, Glaxo Smith Kline, Aerocrine and Vitalograph, outside the submitted work;.Conflict of interest: Dr. Upham reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Yang reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Reynolds reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Hodge reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. JENKINS reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Peters reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Marks reports grants from NHMRC, during the conduct of the study; grants and other from AstraZeneca, grants from GSK, outside the submitted work;.Conflict of interest: Dr. James reports grants from NHMRC, during the conduct of the study;.Conflict of interest: Dr. Simpson reports grants from NHMRC, during the conduct of the study;.