Economic Evaluation of Fluticasone Propionate/ Formoterol (Flutiform ) vs. Fluticasone/Salmeterol and Budesonide/Formoterol in Spain.

Introduction: The aim of this economic evaluation was to estimate the cost-effectiveness of fluticasone propionate/formoterol (FP/FORM; Flutiform ) and compare it to those of fluticasone/ salmeterol (FS) and budesonide/formoterol (BF) when used in the treatment of adult patients with moderate-to-severe asthma. Methods: A Markov model was developed with five asthma health states: successful control, suboptimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. The time horizon was set at 12 months. Transition probabilities and indirect resource utilization were derived from previous international and Spanish publications. Univariate and probabilistic sensitivity analyses (SAs) were applied. Results: FP/FORM was less expensive to acquire than FS or BF (20% lower than FS and 30% lower than BF), while the quality-adjusted life years (QALYs) of the three options compared were very similar. Cost per patient in the FP/FORM cohort was 9326€/year, making it the cheapest option, 1.5% cheaper than FS and 2.6% cheaper than BF. The suboptimal control health state dominated the costs (80% of the total cost) in each of the analyzed options and scenarios. The results of the SAs verified the data obtained from the base case scenario. Conclusions: From a Spanish societal perspective, in 2014, FP/FORM produced a similar gain in QALYs but at a lower cost when compared to FS and BF in a highly meaningful number of replications and scenarios. FP/FORM can therefore be considered a cost-effective option in the treatment of moderate-to-severe asthma in Spain. The cost savings were mainly due to the significantly lower acquisition cost of FP/FORM than the other two options.post-print872 K

Potential Impact of Mepolizumab in Stepping Down Anti-Osteporotic Treatment in Corticosteroid-Dependent Asthma

Oral corticosteroids (OCS) are commonly used for the acute management of severe asthma exacerbations or as maintenance therapy; however, chronic use is associated with significant toxicities, e.g., osteoporosis. In the REal worlD Effectiveness and Safety (REDES) study of mepolizumab in a multicentric Spanish cohort of asthma patients, mepolizumab effectively reduced clinically severe asthma exacerbations and decreased OCS dependence. This post-hoc analysis further evaluates mepolizumab's de-escalation effect on OCS dose. Patients enrolled in REDES who had OCS consumption data available for 12 months pre- and post-mepolizumab treatment were included in this analysis. Primary outcomes were to determine the change in the proportion of patients eligible for anti-osteoporotic treatment due to the changes in OCS consumption before and after 1 year of mepolizumab treatment. All analyses are descriptive. Approximately one-third (98/318; 30.8%) of patients in REDES were on maintenance OCS at the time of mepolizumab treatment initiation. In REDES, mean cumulative OCS exposure decreased by 54.3% after 1 year of treatment. The proportion of patients on high-dose OCS (≥7.5 mg/day) fell from 57.1% at baseline to 28.9% after 12 months of mepolizumab treatment. Thus, 53.6% of OCS-dependent asthma patients treated with mepolizumab would cease to be candidates for anti-osteoporotic treatment according to guidelines thresholds

Sex bias in diagnostic delay in bronchiectasis : An analysis of the Spanish Historical Registry of Bronchiectasis

Diagnostic delay is common in most respiratory diseases, particularly in bronchiectasis. However, sex bias in diagnostic delay has not been studied to date. Objective: Assessment of diagnostic delay in bronchiectasis by sex. Methods: The Spanish Historical Registry of Bronchiectasis recruited adults diagnosed with bronchiectasis from 2002 to 2011 in 36 centres in Spain. From a total of 2113 patients registered we studied 2099, of whom 1125 (53.6%) were women. Results: No differences were found for sex or age (61.0 ± 20.6, p = 0.88) or for localization of bronchiectasis (p = 0.31). Bronchiectasis of unknown aetiology and secondary to asthma, childhood infections and tuberculosis was more common in women (all p s 2 years). Independent factors associated with this sex bias were age at onset of symptoms, smoking history, daily expectoration and reduced lung function

Sex bias in diagnostic delay in bronchiectasis: An analysis of the Spanish Historical Registry of Bronchiectasis

Diagnostic delay is common in most respiratory diseases, particularly in bronchiectasis. However, sex bias in diagnostic delay has not been studied to date. Objective: Assessment of diagnostic delay in bronchiectasis by sex. Methods: The Spanish Historical Registry of Bronchiectasis recruited adults diagnosed with bronchiectasis from 2002 to 2011 in 36 centres in Spain. From a total of 2113 patients registered we studied 2099, of whom 1125 (53.6%) were women. Results: No differences were found for sex or age (61.0 ± 20.6, p = 0.88) or for localization of bronchiectasis (p = 0.31). Bronchiectasis of unknown aetiology and secondary to asthma, childhood infections and tuberculosis was more common in women (all ps 2 years). Independent factors associated with this sex bias were age at onset of symptoms, smoking history, daily expectoration and reduced lung function

Effectiveness and pharmacoeconomic analysis of the treatment of severe asthma with omalizumab in clinical practice

Objetivo: Evaluar el gasto sociosanitario tras la incorporación de omalizumab al tratamiento estándar en el control del asma grave, así como analizar su efectividad, en condiciones de práctica clínica. Método: Estudio observacional, retrospectivo y multicéntrico realizado en 12 servicios de neumología de la Comunidad Valenciana. Se analizaron datos de 186 pacientes. Se compararon resultados del año previo y los cinco años posteriores a la incorporación de omalizumab. La efectividad se calculó a partir del incremento de tres puntos en el Asthma Control Test y la reducción del número de exacerbaciones anuales. La utilidad se calculó mediante el número de años de vida ajustados por calidad. En la evaluación económica se incluyeron costes directos e indirectos. Los resultados se expresaron en términos de relación coste-efectividad incremental y relación coste-utilidad incremental. Resultados: Se detectaron mejoras significativas en la función pulmonar, el control del asma, la calidad de vida y el número de años de vida ajustados por calidad, entre el año anterior y el posterior al inicio de omalizumab. Teniendo en cuenta los costes directos e indirectos, la relación coste-efectividad incremental por exacerbación evitada fue de 1.789,28 € (intervalo de confianza 95%: 1.019,13-3.038,12) y de 4.569,38 € (intervalo de confianza 95%: 3.442,86-6.075,05) por incremento de tres puntos en el Asthma Control Test. La relación coste-utilidad incremental por número de años de vida ajustados por calidad ganada fue de 50.239,98 € (intervalo de confianza 95%: 37.209,88-68.923,84). Conclusiones: La introducción de omalizumab en el tratamiento del asma grave es efectiva en condiciones de práctica clínica. Disminuye los costes directos e indirectos y proporciona mejoras significativas en el estado de salud de los pacientesObjective: To assess socio-sanitary expenditure after the addition of omalizumab to standard treatment in the control of severe asthma and to analyse its effectiveness under standard clinical practice. Method: Observational retrospective multicentre study conducted in 12 pneumology services in the Valencian Community, Spain. Data from 186 patients were analysed. Results of the year before and after the addition of omalizumab were compared. Effectiveness was calculated based on a 3-point increase in the Asthma Control Test and a reduction in the number of annual exacerbations. Utility was calculated by the number of quality adjusted life years. The economic assessment included both direct and indirect costs and results were expressed in terms of incremental cost-effectiveness and incremental cost-utility ratio. Results: Significant improvements were found in lung function, asthma control, quality of life, and quality adjusted life years between the year before and after the introduction of omalizumab. Taking into account direct and indirect costs, the incremental cost-effectiveness for each avoided exacerbation was € 1,789.28 (95% CI: € 1,019.13-3,038.12) and € 4,569.38 (95% CI: 3,442.86-6,075.05) per 3-point increase in the Asthma Control Test score. The incremental cost-utility ratio per quality adjusted life years gained was € 50,239.98 (95% CI: 37,209.88-68,923.84). Conclusions: The addition of omalizumab to the treatment regime of patients with severe asthma is effective under standard clinical practice, decreases direct and indirect costs, and provides significant improvements in the health status of patients

The Response to Biologics is Better in Patients with Severe Asthma Than in Patients with Asthma–COPD Overlap Syndrome

Although biologics have demonstrated to be effective in T2-high asthma patients, there is little experience with these drugs in asthma-COPD overlap (ACO). The aim of this study was to compare the effectiveness of biologics in these two conditions. We included 318 patients (24 ACO and 297 asthma) treated with monoclonal antibodies and followed for at least 12 months Omalizumab was the most frequently employed biologic agent both in patients with ACO and asthma. Asthma control test (ACT) scores after at least 12 months of biologic therapy were not significantly different between groups. The percentage of patients with >= 1 exacerbation and >= 1 corticosteroid burst was significantly higher in ACO patients (70.8 vs 27.3 and 83.3% vs 37.5%, respectively), whereas the percentage of controlled patients (with no exacerbations, no need for corticosteroids and ACT >= 20) was significantly lower (16.7% vs 39.7%). In conclusion, this report suggests that patients with ACO treated with biologics reach worse outcomes than asthma patients

What pulmonologists think about the asthma-COPD overlap syndrome

Some patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β-agonist/inhaled corticosteroids

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality