human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study aim ed to evaluate the cost-effectiveness of formoterol ( Oxis ) Turbuhaler 4.5 microg and salbutamol 200 microg as reliever medications in Sweden and Spain . The study used data on effectiveness ( exacerbations and symptom-free days ) and re source utilisation from an open , 6-month , parallel-group , multicentre r and omised trial with 18,124 asthma patients in 24 countries . Country-specific unit costs for Sweden and for Spain were used to transform re source utilisation data into costs . Total healthcare costs were not significantly different between formoterol and salbutamol dry powder inhalers in Sweden , whereas in Spain , the healthcare costs were 20 % higher for formoterol vs. salbutamol pressurised metered dose inhalers . Total healthcare costs increased with disease severity , defined according to the Global Initiative for Asthma guidelines . Compared with salbutamol , formoterol produced statistically significant improvements in effectiveness , less reliever and maintenance medication usage , reduced healthcare re source utilisation , with no increase or a limited increase in healthcare cost BACKGROUND The Inhaled Steroid as Regular Therapy in Early Asthma ( START ) study reported that early intervention with budesonide in mild persistent asthma reduces severe asthmatic events and improves symptom outcomes and lung function in adults and children . OBJECTIVE We sought to estimate the incremental cost-effectiveness of early intervention with budesonide , as observed within the START study . METHODS START was a r and omized , 3-year controlled trial of budesonide in early onset mild asthma among 7165 subjects ages 5 to 66 years . Three age groups ( 5 - 10 , 11 - 17 , and > or=18 years ) were studied separately and overall . Differences in the probability of emergency treatments , symptom-free days ( SFDs ) , and costs of health care were determined . Incremental cost-effectiveness ratios were estimated from the health care payer and societal perspectives . RESULTS Compared with usual therapy , patients receiving budesonide experienced an average of 14.1 ( SE , 1.3 ) more SFDs per year ( P < .001 ) , fewer hospital days ( 69 % , P < .001 ) , and fewer emergency department visits ( 67 % , P < .05 ) . From the health care payer perspective , the net cost of early use of budesonide was an additional US dollars 0.42 ( SE , dollars 0.04 ) per day , and the result ant cost-effectiveness ratio was US dollars 11.30 ( 95 % CI , US dollars 8.60-US dollars 14.90 ) per SFD gained . From the societal perspective , the cost offsets of lower absence from school or work reduced the net cost of early budesonide to US dollars 0.14 ( SE , US dollars 0.07 ) per day and decreased the cost-effectiveness ratio to US dollars 3.70 ( 95 % CI , US dollars 0.10-US dollars 8.00 ) . Early intervention was more effective and cost saving in the youngest age group . CONCLUSION Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset Abstract Objective : The aim of this study was to determine the relative economic consequences of treating asthmatics with twice daily dry powder formoterol 12 mg as compared with salmeterol 50 mg from a societal perspective . Design and Setting : A r and omised , 6-month , open-label study including 482 patients with asthma was conducted in Italy , Spain , France , Switzerl and , the UK and Sweden .  Medical costs included the costs of medications , physician services , emergency room visits , hospital admissions and lung function and other tests . Travel costs and costs of production loss were also calculated . Unit prices were estimated from external sources . To pool the costs of the 6 countries , European currencies were converted to US dollars using 1995 exchange rates . Outcome measures were the number of episode-free days ( EFDs ) and the number of patients reaching a clinical ly relevant improvement in quality of life as measured using the St. Georges Respiratory Question naire . Main outcome measures and results : There were no significant differences between the 2 treatment arms in the frequency of emergency room visits , hospital admissions , use of rescue medication or contacts with general practitioners ( GPs ) , specialists or nurses . Median medical costs over 6 months were $ US828 per patient with formoterol and $ US850 with salmeterol . This difference was not statistically significant . In both groups , about 60 % of all days were episode-free . Average costs per EFD were about $ US9 for both treatments . The average cost per patient reaching a clinical ly relevant improvement in quality of life was between $ US1300 and $ US1400 . Incremental cost-effectiveness ratios were not calculated because both costs and outcomes were not significantly different . Asthma-related absenteeism ranged between 3 days and 6 months per patient in both groups . Conclusions : There was no evidence to suggest that either treatment was more cost effective than the other Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose , adding a long-acting beta2-agonist , or both . This study assessed the cost-effectiveness of these options . Patients aged > or = 12 years with mild-to-moderate persistent asthma ( n = 1272 ) were r and omised to twice-daily , double-blind treatment with budesonide 100 microg , budesonide 100 microg plus formoterol 4.5 microg , budesonide 200 microg , or budesonide 200 microg plus formoterol 4.5 microg for 12 months . Clinical variables included lung function , number of symptom-free days and number of severe exacerbations . Data on medication use , hospitalisation , visits to health professionals and time off work due to asthma were combined with Swedish unit cost data ( 1999 ) to estimate the mean annual cost per patient . Budesonide 200 microg plus formoterol 4.5 microg had the greatest efficacy and effectiveness .  Budesonide 200 microg plus formoterol 4.5 microg was both more effective and less costly than budesonide 100 microg plus formoterol 4.5 microg , so a cost-effectiveness ratio was not calculated for this comparison . The cost-effectiveness ratio for budesonide 200 microg plus formoterol 4.5 microg compared with budesonide 200 microg alone was SEK 21 per symptom-free days gained . The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost Early intervention with budesonide is an effective strategy for mild persistent asthma , which has been shown to provide additional clinical benefits at a low incremental cost using USA cost data . The present authors analysed whether this strategy would be cost-effective using cost data for other countries . Based on the 3-yr prospect i ve , r and omised , double-blind inhaled Steroid Treatment As Regular Therapy ( START ) in early asthma study ( comparing budesonide and placebo combined with usual asthma therapy ) , the cost-effectiveness was estimated separately for eight different countries , from both healthcare payer and societal perspectives , of adding budesonide to usual asthma therapy .  Local unit costs were applied to data for the total trial population . Incremental cost-effectiveness ratios ( ICER ) were estimated as cost per symptom-free day ( SFD ) gained .  Budesonide  increased SFDs by an average of 14.1 days annually . From a healthcare payer perspective , budesonide would reduce the total cost of asthma care in Australia . In Sweden , Canada , France , Spain , UK , China and the USA , the ICER ranged from US$ 2.4–11.3 per SFD . From a societal perspective , budesonide would be cost-saving in Australia , Canada and Sweden . In conclusion , for countries where costs with budesonide are higher , the policy implication has to be determined by that health system 's willingness to pay for an additional symptom-free day . However , where budesonide therapy increases symptom-free days and reduces total costs , the policy conclusion clearly favours early intervention BACKGROUND The choice of treatment can have a major impact on the total costs associated with asthma care . OBJECTIVE To determine the relative cost-effectiveness of twice-daily treatment with inhaled fluticasone propionate-salmeterol via Diskus , 100/50 microg , with that of once-daily treatment with oral montelukast as initial maintenance therapy in patients with persistent asthma uncontrolled with a short-acting beta2-agonist alone . METHODS Data from a r and omized , double-blind , double-dummy , 12-week clinical trial were analyzed . Efficacy end points included ( 1 ) symptom-free days ( SFDs ) during the 12-week period and ( 2 ) a 12 % or greater increase in forced expiratory volume in 1 second ( FEV1 ) from baseline . The economic analysis was performed from a payer 's perspective , and hence only direct costs were included in the analysis . The incremental cost-effectiveness ratio ( ICER ) , which is the mean difference in average costs divided by the mean difference in average effectiveness , was calculated for both effectiveness outcomes ( SFDs and FEV1 ) . RESULTS For the SFDs end point , the ICER for fluticasone propionate-salmeterol vs montelukast was $ 2.87 ( 95 % confidence interval , -$1.08 to $ 6.65 ) , indicating that it costs , on average , an extra $ 2.87 per day for an additional SFD with fluticasone propionate-salmeterol than with montelukast . With regard to FEV1 , the ICER was $ 1.79 ( 95 % confidence interval , -$0.72 to $ 3.86 ) , indicating that it costs , on average , an extra $ 1.79 per day to achieve a lung function improvement of 12 % or greater from baseline with fluticasone propionate-salmeterol than with montelukast . At a widely acceptable ceiling ratio of $ 9.95 per day , the probability of fluticasone propionate-salmeterol being more cost-effective than montelukast was 99.8 % for SFDs and was almost 100 % for an FEV1 improvement of 12 % of greater . CONCLUSIONS Treating 2 main components of asthma , inflammation and smooth muscle dysfunction , using fluticasone propionate-salmeterol is more cost-effective than using a single mediator antagonist alone , such as montelukast , as initial maintenance therapy for persistent asthma in patients treated with a short-acting beta2-agonist only STUDY OBJECTIVES To evaluate the cost-effectiveness of inhaled fluticasone propionate ( FP ) in children aged 12 to 47 months with asthma symptoms . DESIGN A retrospective economic analysis conducted from the perspective of the Danish health-care system , based on clinical data from a 12-week study . SETTING Thirty-three outpatient centers in nine countries . PATIENTS Two hundred thirty-seven children aged 12 to 47 months with documented history of recurrent wheeze or asthma symptoms . INTERVENTIONS Two dosages of FP , 100 microg/d and 200 microg/d , and placebo administered in two divided doses via a metered-dose inhaler and a Babyhaler ( Glaxo Wellcome ; Middlesex , UK ) spacer device . MEASUREMENTS Effectiveness in terms of asthma exacerbations , control of cough and wheeze symptoms , symptom-free days , overall direct costs of asthma management in Danish kroner at 1999 prices , and mean and incremental cost-effectiveness ratios . RESULTS FP , 200 microg/d , was significantly more effective than placebo treatment in terms of the proportion of exacerbation-free patients ( 73.7 % vs 59.8 % ; p = 0.025 ) and patients experiencing a > or = 25 % improvement in cough symptoms ( 57.9 % vs 39.0 % ; p = 0.018 ) . The costs per exacerbation-free patient , per patient with a > or = 25 % improvement in cough and wheeze symptoms from baseline , and per symptom-free day were lower in the FP groups than in the placebo group . The incremental cost-effectiveness ratios for these end points indicated that the additional benefits of FP , 200 microg/d , were achieved at a lower overall cost compared with placebo treatment . CONCLUSIONS From the perspective of the Danish health-care system , FP , 100 microg bid , administered via the Babyhaler inhalation device was cost-effective relative to st and ard therapy with bronchodilators alone Abstract Background and objective : Asthma is a chronic-episodic disease characterised by acute , symptomatic episodes of varying severity . We developed a Markov model that can be used to estimate the cost effectiveness of alternative asthma treatments . Because of the costs they incur , asthma exacerbations ( ‘ attacks ’ ) requiring intervention by a healthcare professional were a central consideration in the development of the model . Methods : Treatment success was assessed as asthma control , a composite measure based on goals defined in world-wide asthma management guidelines and in terms of quality -adjusted life-years ( QALYs ) . The data from which the transition probabilities were derived came from patients with asthma who received either salmeterol/fluticasone propionate combination ( SFC ) 50/100μg or fluticasone propionate ( FP ) 100μg , administered twice daily via an inhal 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study aim ed to evaluate the cost-effectiveness of formoterol ( Oxis ) Turbuhaler 4.5 microg and salbutamol 200 microg as reliever medications in Sweden and Spain . The study used data on effectiveness ( exacerbations and symptom-free days ) and re source utilisation from an open , 6-month , parallel-group , multicentre r and omised trial with 18,124 asthma patients in 24 countries . Country-specific unit costs for Sweden and for Spain were used to transform re source utilisation data into costs . Total healthcare costs were not significantly different between formoterol and salbutamol dry powder inhalers in Sweden , whereas in Spain , the healthcare costs were 20 % higher for formoterol vs. salbutamol pressurised metered dose inhalers . Total healthcare costs increased with disease severity , defined according to the Global Initiative for Asthma guidelines . Compared with salbutamol , formoterol produced statistically significant improvements in effectiveness , less reliever and maintenance medication usage , reduced healthcare re source utilisation , with no increase or a limited increase in healthcare cost BACKGROUND The Inhaled Steroid as Regular Therapy in Early Asthma ( START ) study reported that early intervention with budesonide in mild persistent asthma reduces severe asthmatic events and improves symptom outcomes and lung function in adults and children . OBJECTIVE We sought to estimate the incremental cost-effectiveness of early intervention with budesonide , as observed within the START study . METHODS START was a r and omized , 3-year controlled trial of budesonide in early onset mild asthma among 7165 subjects ages 5 to 66 years . Three age groups ( 5 - 10 , 11 - 17 , and > or=18 years ) were studied separately and overall . Differences in the probability of emergency treatments , symptom-free days ( SFDs ) , and costs of health care were determined . Incremental cost-effectiveness ratios were estimated from the health care payer and societal perspectives . RESULTS Compared with usual therapy , patients receiving budesonide experienced an average of 14.1 ( SE , 1.3 ) more SFDs per year ( P < .001 ) , fewer hospital days ( 69 % , P < .001 ) , and fewer emergency department visits ( 67 % , P < .05 ) . From the health care payer perspective , the net cost of early use of budesonide was an additional US dollars 0.42 ( SE , dollars 0.04 ) per day , and the result ant cost-effectiveness ratio was US dollars 11.30 ( 95 % CI , US dollars 8.60-US dollars 14.90 ) per SFD gained . From the societal perspective , the cost offsets of lower absence from school or work reduced the net cost of early budesonide to US dollars 0.14 ( SE , US dollars 0.07 ) per day and decreased the cost-effectiveness ratio to US dollars 3.70 ( 95 % CI , US dollars 0.10-US dollars 8.00 ) . Early intervention was more effective and cost saving in the youngest age group . CONCLUSION Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset Abstract Objective : The aim of this study was to determine the relative economic consequences of treating asthmatics with twice daily dry powder formoterol 12 mg as compared with salmeterol 50 mg from a societal perspective . Design and Setting : A r and omised , 6-month , open-label study including 482 patients with asthma was conducted in Italy , Spain , France , Switzerl and , the UK and Sweden .  Medical costs included the costs of medications , physician services , emergency room visits , hospital admissions and lung function and other tests . Travel costs and costs of production loss were also calculated . Unit prices were estimated from external sources . To pool the costs of the 6 countries , European currencies were converted to US dollars using 1995 exchange rates . Outcome measures were the number of episode-free days ( EFDs ) and the number of patients reaching a clinical ly relevant improvement in quality of life as measured using the St. Georges Respiratory Question naire . Main outcome measures and results : There were no significant differences between the 2 treatment arms in the frequency of emergency room visits , hospital admissions , use of rescue medication or contacts with general practitioners ( GPs ) , specialists or nurses . Median medical costs over 6 months were $ US828 per patient with formoterol and $ US850 with salmeterol . This difference was not statistically significant . In both groups , about 60 % of all days were episode-free . Average costs per EFD were about $ US9 for both treatments . The average cost per patient reaching a clinical ly relevant improvement in quality of life was between $ US1300 and $ US1400 . Incremental cost-effectiveness ratios were not calculated because both costs and outcomes were not significantly different . Asthma-related absenteeism ranged between 3 days and 6 months per patient in both groups . Conclusions : There was no evidence to suggest that either treatment was more cost effective than the other Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose , adding a long-acting beta2-agonist , or both . This study assessed the cost-effectiveness of these options . Patients aged > or = 12 years with mild-to-moderate persistent asthma ( n = 1272 ) were r and omised to twice-daily , double-blind treatment with budesonide 100 microg , budesonide 100 microg plus formoterol 4.5 microg , budesonide 200 microg , or budesonide 200 microg plus formoterol 4.5 microg for 12 months . Clinical variables included lung function , number of symptom-free days and number of severe exacerbations . Data on medication use , hospitalisation , visits to health professionals and time off work due to asthma were combined with Swedish unit cost data ( 1999 ) to estimate the mean annual cost per patient . Budesonide 200 microg plus formoterol 4.5 microg had the greatest efficacy and effectiveness .  Budesonide 200 microg plus formoterol 4.5 microg was both more effective and less costly than budesonide 100 microg plus formoterol 4.5 microg , so a cost-effectiveness ratio was not calculated for this comparison . The cost-effectiveness ratio for budesonide 200 microg plus formoterol 4.5 microg compared with budesonide 200 microg alone was SEK 21 per symptom-free days gained . The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost Early intervention with budesonide is an effective strategy for mild persistent asthma , which has been shown to provide additional clinical benefits at a low incremental cost using USA cost data . The present authors analysed whether this strategy would be cost-effective using cost data for other countries . Based on the 3-yr prospect i ve , r and omised , double-blind inhaled Steroid Treatment As Regular Therapy ( START ) in early asthma study ( comparing budesonide and placebo combined with usual asthma therapy ) , the cost-effectiveness was estimated separately for eight different countries , from both healthcare payer and societal perspectives , of adding budesonide to usual asthma therapy .  Local unit costs were applied to data for the total trial population . Incremental cost-effectiveness ratios ( ICER ) were estimated as cost per symptom-free day ( SFD ) gained .  Budesonide  increased SFDs by an average of 14.1 days annually . From a healthcare payer perspective , budesonide would reduce the total cost of asthma care in Australia . In Sweden , Canada , France , Spain , UK , China and the USA , the ICER ranged from US$ 2.4–11.3 per SFD . From a societal perspective , budesonide would be cost-saving in Australia , Canada and Sweden . In conclusion , for countries where costs with budesonide are higher , the policy implication has to be determined by that health system 's willingness to pay for an additional symptom-free day . However , where budesonide therapy increases symptom-free days and reduces total costs , the policy conclusion clearly favours early intervention BACKGROUND The choice of treatment can have a major impact on the total costs associated with asthma care . OBJECTIVE To determine the relative cost-effectiveness of twice-daily treatment with inhaled fluticasone propionate-salmeterol via Diskus , 100/50 microg , with that of once-daily treatment with oral montelukast as initial maintenance therapy in patients with persistent asthma uncontrolled with a short-acting beta2-agonist alone . METHODS Data from a r and omized , double-blind , double-dummy , 12-week clinical trial were analyzed . Efficacy end points included ( 1 ) symptom-free days ( SFDs ) during the 12-week period and ( 2 ) a 12 % or greater increase in forced expiratory volume in 1 second ( FEV1 ) from baseline . The economic analysis was performed from a payer 's perspective , and hence only direct costs were included in the analysis . The incremental cost-effectiveness ratio ( ICER ) , which is the mean difference in average costs divided by the mean difference in average effectiveness , was calculated for both effectiveness outcomes ( SFDs and FEV1 ) . RESULTS For the SFDs end point , the ICER for fluticasone propionate-salmeterol vs montelukast was $ 2.87 ( 95 % confidence interval , -$1.08 to $ 6.65 ) , indicating that it costs , on average , an extra $ 2.87 per day for an additional SFD with fluticasone propionate-salmeterol than with montelukast . With regard to FEV1 , the ICER was $ 1.79 ( 95 % confidence interval , -$0.72 to $ 3.86 ) , indicating that it costs , on average , an extra $ 1.79 per day to achieve a lung function improvement of 12 % or greater from baseline with fluticasone propionate-salmeterol than with montelukast . At a widely acceptable ceiling ratio of $ 9.95 per day , the probability of fluticasone propionate-salmeterol being more cost-effective than montelukast was 99.8 % for SFDs and was almost 100 % for an FEV1 improvement of 12 % of greater . CONCLUSIONS Treating 2 main components of asthma , inflammation and smooth muscle dysfunction , using fluticasone propionate-salmeterol is more cost-effective than using a single mediator antagonist alone , such as montelukast , as initial maintenance therapy for persistent asthma in patients treated with a short-acting beta2-agonist only STUDY OBJECTIVES To evaluate the cost-effectiveness of inhaled fluticasone propionate ( FP ) in children aged 12 to 47 months with asthma symptoms . DESIGN A retrospective economic analysis conducted from the perspective of the Danish health-care system , based on clinical data from a 12-week study . SETTING Thirty-three outpatient centers in nine countries . PATIENTS Two hundred thirty-seven children aged 12 to 47 months with documented history of recurrent wheeze or asthma symptoms . INTERVENTIONS Two dosages of FP , 100 microg/d and 200 microg/d , and placebo administered in two divided doses via a metered-dose inhaler and a Babyhaler ( Glaxo Wellcome ; Middlesex , UK ) spacer device . MEASUREMENTS Effectiveness in terms of asthma exacerbations , control of cough and wheeze symptoms , symptom-free days , overall direct costs of asthma management in Danish kroner at 1999 prices , and mean and incremental cost-effectiveness ratios . RESULTS FP , 200 microg/d , was significantly more effective than placebo treatment in terms of the proportion of exacerbation-free patients ( 73.7 % vs 59.8 % ; p = 0.025 ) and patients experiencing a > or = 25 % improvement in cough symptoms ( 57.9 % vs 39.0 % ; p = 0.018 ) . The costs per exacerbation-free patient , per patient with a > or = 25 % improvement in cough and wheeze symptoms from baseline , and per symptom-free day were lower in the FP groups than in the placebo group . The incremental cost-effectiveness ratios for these end points indicated that the additional benefits of FP , 200 microg/d , were achieved at a lower overall cost compared with placebo treatment . CONCLUSIONS From the perspective of the Danish health-care system , FP , 100 microg bid , administered via the Babyhaler inhalation device was cost-effective relative to st and ard therapy with bronchodilators alone Abstract Background and objective : Asthma is a chronic-episodic disease characterised by acute , symptomatic episodes of varying severity . We developed a Markov model that can be used to estimate the cost effectiveness of alternative asthma treatments . Because of the costs they incur , asthma exacerbations ( ‘ attacks ’ ) requiring intervention by a healthcare professional were a central consideration in the development of the model . Methods : Treatment success was assessed as asthma control , a composite measure based on goals defined in world-wide asthma management guidelines and in terms of quality -adjusted life-years ( QALYs ) . The data from which the transition probabilities were derived came from patients with asthma who received either salmeterol/fluticasone propionate combination ( SFC ) 50/100μg or fluticasone propionate ( FP ) 100μg , administered twice daily via an inhal 
    Output:
    