Abstract
Background: The Global Initiative for Asthma strategy recommends as-needed combination inhaled corticosteroid (ICS)-formoterol reliever for mild asthma. Its cost-effectiveness is uncertain outside of double-blind regulatory trials.
Objectives: Assess the cost-effectiveness of as-needed budesonide-formoterol versus maintenance budesonide plus as-needed salbutamol, and versus as-needed salbutamol, in averting exacerbations in adults with mild asthma during 12-month follow-up from the New Zealand (NZ) participants (n=551) of the open-label Novel START multi-country clinical trial.
Methods: NZ health-system and societal perspectives were adopted using 2025 resource costs. Healthcare utilisation comprised electronically-monitored inhaler use (with multiple imputation used for missing data), asthma-related pharmaceuticals, primary-care visits, emergency-department visits and hospitalisations. Regression methods were used for cost-effectiveness analysis. Scenarios included generic substitution and prescription-charge exemption.
Results: As-needed budesonide-formoterol, compared to maintenance budesonide plus as-needed salbutamol, is more effective at reducing severe exacerbations and provides an annual health-system cost-saving per patient of NZ$12 (95% CI: 0, 28) increasing to a NZ$22 (95% CI: −15, 58) cost-saving if a societal perspective is adopted. Compared to as-needed salbutamol alone, as-needed budesonide-formoterol costs the health system NZ$38 and NZ$111, respectively, to prevent an exacerbation and a severe exacerbation. From a societal perspective it is cost-saving NZ$70 (95% CI: 2, 134). Findings were robust to scenario analyses.
Conclusions: For patients with mild asthma, as-needed budesonide-formoterol 200/6ug is cost-saving from health-system, patient and societal perspectives, while improving health outcomes, dominating maintenance budesonide plus as-needed salbutamol. Compared to as-needed salbutamol alone, as-needed budesonide-formoterol is cost-effective from a health-system perspective and dominates from a societal perspective.