Importantly, these estimates used hospitalised exacerbation rates as a conservative estimate of total exacerbation rates (hospital management and those treated at the local clinic as outpatients).
When the total exacerbation burden was considered, using studies that reported both moderate and severe exacerbations, combined maintenance and reliever treatment ranked highest, approximately halving the risk of exacerbations compared with low dose inhaled corticosteroids.
Total exacerbations included exacerbations of any severity (inpatient, emergency room, ambulatory by qualifying diagnosis, or ambulatory supported by drug therapy).
6– 9, 31, 32, 34– 42, 42– 53, 54, 54 These data contributed to our first analysis of total exacerbations.
Risk was assessed according to the spirometric classification (high risk: severe and very-severe) and/or total exacerbations in the past year (high risk: ≥ 2 exacerbations).
Evaluation of exacerbations by complexity group demonstrates a general increase in the percentage of patients experiencing total exacerbations and hospitalized exacerbations with increasing disease complexity in both age cohorts.
In comparison with low dose inhaled corticosteroids, we identified combined maintenance and reliever treatment as the highest ranked strategy for preventing total exacerbations (composite of moderate or severe), and equally ranked with combined fixed dose treatment for preventing severe exacerbations.
For the selected timeframe (1 40 years) and probabilistic analysis, model outputs included disaggregated costs, total costs, exacerbations, life-years and QALYs gained, and incremental cost-effectiveness ratios (ICERs).
This comprehensive network meta-analysis shows that combined inhaled corticosteroids and long acting β agonists as maintenance and reliever treatment has a good safety profile and is better in preventing total asthma exacerbations than low dose inhaled corticosteroids alone.
The number of exacerbations will be reported as weighted exacerbations rates (total number of exacerbations divided by the total person-time of follow up per group) [ 43- 45].
Exacerbation frequency is reported for both total and hospitalized exacerbations as percent of patients experiencing ≥1 exacerbation(s), percent of patients experiencing multiple (≥2) exacerbations, and number of exacerbations/COPD patient.
