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Abstract
Objective
Two identical 24-week, double-blind, placebo-controlled trials of tobramycin solution
for inhalation (TOBI® [PathoGenesis Corporation, Seattle, Washington]) in cystic fibrosis patients with
chronic Pseudomonas aeruginosa infection were conducted in the United States. The aim of the present study was to
extrapolate the US trial data to a Canadian setting, using Canadian costs to estimate
the savings in direct medical costs that might result from use of a similar 24-week
TOBI regimen versus usual care in 2 Canadian provinces.
Background
Cystic fibrosis is a genetic disease in which persistent respiratory infection, usually
due to P aeruginosa infection, is the major cause of morbidity and mortality.
Methods
The US trials demonstrated that TOBI produced significant improvements in pulmonary
function test results, reduced sputum levels of P aeruginosa, and resulted in a 26% reduction in the probability of hospitalization (95% CI, 2%–43%
vs placebo in the clinical trials). Individual patient data from the US trials were
used to calculate the mean number of days in hospital as well as the mean number of
days of home intravenous or oral antibiotic therapy. To adjust for Canadian pricing,
pertinent economic data were obtained from Statistics Canada and the Ontario and Quebec
health ministries. Demographic and baseline data were obtained from health surveys
conducted by the Canadian Cystic Fibrosis Foundation.
Results
Economic analysis showed that the use of TOBI for 24 weeks would result in estimated
mean per-patient savings in direct medical costs (in Canadian dollars) of $4055 in
Ontario and $4916 in Quebec, which would substantially offset the Canadian acquisition
price of $8602 for the same 24-week period.
Conclusions
Assuming that the percentage of reduction in hospital days observed in the US trials
would also occur in the Canadian clinical setting, use of TOBI would reduce the use
of health care services, particularly hospital days, and lead to substantial savings
in direct medical costs that would offset its acquisition price. Whether this reduction
actually occurs after TOBI enters the Canadian market is a subject for future investigation.
Key words
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Article info
Publication history
Accepted:
November 4,
1999
Identification
Copyright
© 2000 Published by Elsevier Inc.
