Evidence map›Paper›PMID 20446755›Full record

Trial reportPharmacoEconomics2010

Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic trial.

Edward C F Wilson, David Price, Stanley D Musgrave, Erika J Sims, Lee Shepstone, Jamie Murdoch, H Miranda Mugford, Annie Blyth, Elizabeth F Juniper, Jon G Ayres and 5 more

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in PharmacoEconomics, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 6 pooled it
0.7field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 6 syntheses or guidelines pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 5 institutions in 2 countries.

Edward C F WilsonFaculty of Health, University of East Anglia, Norwich, UK. ed.wilson@uea.ac.uk
David Price
Stanley D Musgrave
Erika J Sims
Lee Shepstone
Jamie Murdoch
H Miranda Mugford
Annie Blyth
Elizabeth F Juniper
Jon G Ayres
Stephanie Wolfe
Daryl Freeman
Richard F T Gilbert
Elizabeth V Hillyer
Ian Harvey
University of East Anglia · GBMcMaster University · CANorwich Research Park · GBUniversity of Aberdeen · GBUniversity of Birmingham · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundInformation is lacking on the relative effectiveness and cost effectiveness--in a real-life primary-care setting--of leukotriene receptor antagonists (LTRAs) and long-acting beta2 adrenergic receptor agonists (beta2 agonists) as add-on therapy for patients whose asthma symptoms are not controlled on low-dose inhaled corticosteroids (ICS).

objectiveTo estimate the cost effectiveness of LTRAs compared with long-acting beta2 agonists as add-on therapy for patients whose asthma symptoms are not controlled on low-dose ICS.

methodsAn economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12-80 years with asthma insufficiently controlled with ICS (n = 361) were randomly assigned to add-on LTRAs (n = 176) or long-acting beta2 agonists (n = 185). The main outcome measures were the incremental cost per point improvement in the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), per point improvement in the Asthma Control Questionnaire (ACQ) and per QALY gained from perspectives of the UK NHS and society.

resultsOver 2 years, the societal cost per patient receiving LTRAs was pounds sterling 1157 versus pounds sterling 952 for long-acting beta2 agonists, a (significant, adjusted) increase of pounds sterling 214 (95% CI 2, 411) [year 2005 values]. Patients receiving LTRAs experienced a non-significant incremental gain of 0.009 QALYs (95% CI -0.077, 0.103). The incremental cost per QALY gained from the societal (NHS) perspective was pounds sterling 22,589 (pounds sterling 11,919). Uncertainty around this point estimate suggested that, given a maximum willingness to pay of pounds sterling 30,000 per QALY gained, the probability that LTRAs are a cost-effective alternative to long-acting beta2 agonists as add-on therapy was approximately 52% from both societal and NHS perspectives.

conclusionsOn balance, these results marginally favour the repositioning of LTRAs as a cost-effective alternative to long-acting beta2 agonists as add-on therapy to ICS for asthma. However, there is much uncertainty surrounding the incremental cost effectiveness because of similarity of clinical benefit and broad confidence intervals for differences in healthcare costs.

trial registrationUK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.

Indexed as

Adrenergic beta-2 Receptor AgonistsAdministration, InhalationAdolescentAdrenal Cortex HormonesAdrenergic beta-AgonistsAdultAgedAged, 80 and overAsthmaChildCost-Benefit AnalysisDelayed-Action PreparationsDrug Therapy, CombinationHumansLeukotriene AntagonistsMiddle AgedAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsAdrenergic beta-AgonistsDelayed-Action PreparationsLeukotriene Antagonists

Identifiers

PMID20446755
OpenAlexW2003190574

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.