| Abstract: | SummaryWe aimed to compare the cost-effectiveness of oral bambuterol (Bambec®) 20?mg once daily with that of salmeterol (Serevent®) via pressurised metered dose inhaler (pMDI) 50?µg twice daily for treatment of asthma patients with nocturnal symptoms. One hundred and twenty six patients aged 18-70 years and using inhaled corticosteroids at a constant daily dose and with forced expiratory volume in one second (FEV1) 40-85% of predicted normal value, were included in this double-blind, randomised, parallel-group study (two weeks' run-in, six weeks' treatment) in the United Kingdom, Italy and Norway. During run-in, they had to have a nocturnal awakening or early awakening due to asthma symptoms that required rescue medication at least once during a two-week run-in period, and a > 15% fall in overnight peak expiratory flow (PEF) on at least three out of the last seven days. Morning and evening PEF were measured and tremor was scored. The effectiveness variables in the cost-minimisation analysis were symptom-free days and number of nights with no awakenings. Costs for both study and rescue medication were calculated.There were no statistically significant differences between bambuterol and salmeterol regarding morning and evening PEF (change from baseline), tremor, and the effectiveness variables. Mean number of symptom-free days was 25% vs. 20% and mean number of nights with no awakenings was 69% vs. 77% in the bambuterol and salmeterol groups, respectively. However treatment costs (study plus rescue medication) were lower during bambuterol treatment in all three countries. The per patient cost savings would be 47% in the UK, 27% in Italy and 40% in Norway if a patient changes from salmeterol to bambuterol. The conclusion is that the once-daily treatment with bambuterol is more cost-effective than the twice-daily treatment with salmeterol in asthma patients with nocturnal symptoms. |
