Comparative effectiveness of budesonide/formoterol and fluticasone/salmeterol for COPD management

J Med Econ. 2011;14(6):769-76. doi: 10.3111/13696998.2011.622817. Epub 2011 Sep 27.


Objective: To compare the effectiveness of budesonide/formoterol fumarate dihydrate (BFC) and fluticasone propionate/salmeterol (FSC), two combination inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) products approved for the treatment of chronic obstructive pulmonary disease (COPD) in the US with respect to cost, therapy adherence, and related healthcare utilization. The effectiveness of these two treatments has not previously been compared in a US COPD population.

Methods: A retrospective cohort study assessed COPD-related outcomes using administrative claims data among ICS/LABA-naïve patients. Patients initiating BFC were propensity matched to FSC patients. Cost and effectiveness were measured as total healthcare expenditures, exacerbation events (hospitalizations, emergency department visits, or outpatient visits associated with oral corticosteroid or antibiotic prescription fills), and treatment medication adherence. Differences in COPD symptom control were assessed via proxy measure through claims for rescue medications and outpatient encounters.

Results: Of the 6770 patients (3385 BFC and 3385 FSC), fewer BFC patients had claims for short-acting beta agonists (SABA) (34.7% vs 39.5%; p<0.001) and ipratropium (7.8% vs 9.8%, p<0.005) than FSC patients, but no substantial differences were seen in other clinical outcomes including tiotropium or nebulized SABA claims, COPD-related outpatient visits, or exacerbation events. There were no significant differences in total COPD-related medical costs in the 6-month period after initiation of combination therapy.

Limitations: This was a retrospective observational study using claims data and accuracy of COPD diagnoses could not be verified, nor was information available on severity of disease. The results and conclusions of this study are limited to the population observed and the operational definitions of the study variables.

Conclusions: For most outcomes of interest, BFC and FSC showed comparable real-world effectiveness.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuterol / analogs & derivatives*
  • Albuterol / economics
  • Albuterol / therapeutic use
  • Androstadienes / economics
  • Androstadienes / therapeutic use*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / economics
  • Bronchodilator Agents / therapeutic use*
  • Budesonide / administration & dosage
  • Budesonide / economics
  • Budesonide / therapeutic use*
  • Comorbidity
  • Costs and Cost Analysis
  • Drug Combinations
  • Drug Therapy, Combination
  • Ethanolamines / administration & dosage
  • Ethanolamines / economics
  • Ethanolamines / therapeutic use*
  • Female
  • Fluticasone-Salmeterol Drug Combination
  • Formoterol Fumarate
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / economics
  • Retrospective Studies


  • Androstadienes
  • Bronchodilator Agents
  • Drug Combinations
  • Ethanolamines
  • Fluticasone-Salmeterol Drug Combination
  • Budesonide
  • Albuterol
  • Formoterol Fumarate