A combination inhaler is not always the least costly way to prescribe an inhaled steroid and a LABA
In paragraph two of the article ‘Evidence-based asthma care', it is advised that the least costly combination device is prescribed rather than separate inhalers when introducing a LABA for patients already taking inhaled steroids, on the basis this would be the cheapest way to prescribe.
In fact, a combination inhaler is not, in every case, the least costly way to prescribe an inhaled steroid and a LABA.
Giving the example you use of a budesonide/formoterol combination, the monthly cost ranges from £30.80 to £70.93 depending on the strength prescribed.
If you were to prescribe these separately through the Easyhaler device, monthly costs would range from £16.04 to £30.91 – giving a saving ranging from £14.41 to £40.02 per month.1
The number of combination inhalers prescribed in the UK has increased over recent years and now exceeds that of single-molecule inhaled steroids. This has resulted in significantly increased costs.
In the last five years prescribing of and spending on LABA/steroid preparations has doubled to 2.4 million items costing £125.6m.2
NICE guidance on inhaled steroids for treatment of chronic asthma in adults and children age 12 years and older, published in 2008, and British Thoracic Society guidelines for adult asthma both state there is no difference in clinical efficacy in treatment with an inhaled steroid and a LABA in a combination device compared with separate inhalers.3,4
Where compliance is an issue, a combination device does have the added advantage of ensuring the steroid is taken alongside the LABA, but where it is not an issue separate inhalers can be a more cost-effective treatment.1
1 MIMS. January 2012
2 NHS Business Service Authorities. Asthma and COPD – prescribing guidance and discussion points. 2010
3 NICE. Inhaled steroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal Guidance 138. London 2008
4 BTS and SIGN. British guideline on the management of asthma – a national clinical guideline. 2011. www.sign.ac.uk/guidelines/fulltext/101/index.html
From Bryony Maddams, Product manager, Orion Pharma UK