The cost effectiveness of early treatment with fluticasone propionate 250 microg twice a day in subjects with obstructive airway disease. Results of the DIMCA program

Am J Respir Crit Care Med. 2001 Dec 1;164(11):2057-66. doi: 10.1164/ajrccm.164.11.2003151.


In a two-stage detection program, subjects with signs of obstructive airway disease were selected from a random sample of the general population. Subjects (n = 82) were randomly assigned to either fluticasone propionate 250 microg twice a day or placebo twice a day via pMDI in a 1-yr, double-blind trial if they met criteria for persistent airway obstruction, increased bronchial hyperresponsiveness, or a rapid decline in FEV(1). Main outcome measures were postbronchodilator FEV(1), quality-adjusted life years (QALYs), and direct medical cost. Secondary measures were prebronchodilator FEV(1), PC(20), health-related quality of life (CRQ), symptom-free weeks, episode-free weeks, exacerbations, and indirect cost. Subgroup analysis was based on reversibility of obstruction. Analysis revealed a significant gain in postbronchodilator FEV(1) (98 ml/yr; p = 0.01) in favor of fluticasone. Only subjects with reversible obstruction showed an improvement in PC(20) (1.4 doubling dose; p = 0.03). Early treatment resulted in 2.7 QALYs gained per 100 treated subjects (p = 0.17) and in a clinically relevant improvement in dyspnea (CRQ; p < 0.03). The incremental cost effectiveness ratios were US$13,016/QALY for early treatment and US$33,921/QALY for the combination of detection and treatment. The incremental cost for one additional subject with a clinically relevant difference in dyspnea was US$1,674. In conclusion, early intervention with fluticasone resulted in significant health gains at relatively low financial cost.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Activities of Daily Living
  • Androstadienes / economics*
  • Androstadienes / pharmacology
  • Androstadienes / therapeutic use*
  • Anti-Asthmatic Agents / economics*
  • Anti-Asthmatic Agents / pharmacology
  • Anti-Asthmatic Agents / therapeutic use*
  • Anti-Inflammatory Agents / economics*
  • Anti-Inflammatory Agents / pharmacology
  • Anti-Inflammatory Agents / therapeutic use*
  • Bronchial Hyperreactivity / drug therapy*
  • Bronchial Hyperreactivity / physiopathology
  • Bronchial Hyperreactivity / psychology
  • Cost-Benefit Analysis
  • Direct Service Costs / statistics & numerical data
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Costs / statistics & numerical data
  • Female
  • Fluticasone
  • Forced Expiratory Volume / drug effects
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Quality of Life
  • Quality-Adjusted Life Years
  • Recurrence
  • Time Factors
  • Treatment Outcome


  • Androstadienes
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Fluticasone