Comparison of three alternatives for the management of moderate asthma in children aged 6–11 years: a cost-utility analysis

Abstract

Background

Recent asthma guidelines for children 6–11 years with persistent asthma advocate three alternatives: SMART (budesonide/formoterol 80/4.5 mcg qd plus additional doses as needed), fixed combination of budesonide/formoterol, and fixed-dose budesonide. Concerns have arisen as to which of the proposed alternatives has the best possible cost-effectiveness profile. This study aimed to assess the health and economic consequences of SMART, fixed combination, and fixed-dose budesonide therapy in children 6–11 years old with persistent asthma.

Methods

A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs of SMART, fixed combination, and fixed-dose budesonide therapy were calculated over a time horizon of 6 years. Multiple sensitivity analyses were conducted.

Results

The mean QALY per patient was 0.57 and 0.56 QALYs per patient per year of SMART and fixed combination and 0,52 with fixed-dose budesonide. The total mean of discounted costs per patient per cycle were US$111 for SMART, US$133 for fixed combination, and US$67 for fixed-dose budesonide. The net monetary benefit of SMART was US$12,549, US$12278 for fixed combination, and US$11,380 for fixed-dose budesonide

Conclusion

Our study showed that SMART was more cost-effective than fixed combination and fixed-dose budesonide. These findings complement and support the GINA 2021 and National Asthma Education and Prevention Program asthma guideline recommendations for use of inhaled corticosteroids–formoterol in children 6–11 years old with persistent asthma.

Keywords:

• Budesonide–formoterol
• uncontrolled asthma
• cost-effectiveness analysis
• decision analysis
• Markov model

Acknowledgements

None

Availability of data and material

BD Smart step 3 [Data set]. Zenodo. https://doi.org/10.5281/zenodo.5637470

Declaration of interest

All authors declare that they do not have any conflict of interest with respect to this publication.

Author contributions

All authors contributed equally to the manuscript conceptualization, methodology, analysis, data curation, and review of the text. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

Authors’ own funds.