QUANTIFYING THE COST OF UNCONTROLLED ASTHMA IN MEXICAN PUBLIC HEALTHCARE: CLINICAL AND ECONOMIC VALUE OF ESCALATION TO SINGLE-INHALER TRIPLE THERAPY
Author(s)
José Ángel Paladio-Hernández, MA, MS1, Angélica Hurtado-Vilchis, BA, MS2, Yamilet Ariluk Chávez-Paladio, MD3.
1Head of Health Economics, PalaGod Health Supply, Mexico City, Mexico, 2CHIESI MEXICO, MEXICO CITY, Mexico, 3PalaGod Health Supply, Mexico City, Mexico.
1Head of Health Economics, PalaGod Health Supply, Mexico City, Mexico, 2CHIESI MEXICO, MEXICO CITY, Mexico, 3PalaGod Health Supply, Mexico City, Mexico.
OBJECTIVES: Uncontrolled asthma generates avoidable healthcare expenditure concentrated in exacerbations. From the perspective of the Mexican Institute of Social Security (IMSS), we quantified the direct medical cost attributable to poor control in adults and assessed whether escalation from inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) dual therapy to single-inhaler triple therapy (SITT) improves clinical and economic outcomes.
METHODS: A structured cost-of-non-control analysis was conducted over a 1-year horizon. Direct costs (maintenance and rescue pharmacotherapy, follow-up consultations, and exacerbations) used public institutional acquisition prices (CNIS). Comparative effectiveness for SITT (beclomethasone/formoterol/glycopyrronium) versus dual ICS/LABA was obtained from published phase 3 randomized controlled trial evidence, applying consistent exacerbation rates across comparators. Costs were reported in 2026 MXN and USD (17.53 MXN/USD), with probabilistic sensitivity analysis using gamma distributions.
RESULTS: Adults uncontrolled on dual ICS/LABA incurred an estimated annual direct cost of USD $4,732-$4,818 per patient, of which exacerbations accounted for approximately 94%—confirming poor control, not maintenance pharmacotherapy, as the principal cost driver. Each moderate-to-severe exacerbation represented USD $2,163 in direct cost. SITT reduced exacerbations versus dual therapy (relative reduction ~15%; RR 0.85; p=0.0084; 95% CI −13.1% to −1.9%), corresponding to 1.84 versus 2.16 exacerbations per patient annually. This lowered the annual cost to USD $4,228 per patient with SITT, yielding avoided costs of USD $504-$589 per patient versus dual comparators. SITT was the dominant strategy—lower total cost and fewer exacerbations—across all comparators, as its higher maintenance-drug cost was more than offset by reduced exacerbation-related expenditure. Findings were consistent across probabilistic sensitivity analysis, supporting the robustness of SITT's dominant position.
CONCLUSIONS: The cost of uncontrolled asthma from a Mexican public payer perspective is substantial and largely preventable. Escalating eligible adults from ICS/LABA to single-inhaler triple therapy reduces exacerbations and represents a dominant strategy from the payer perspective, allowing reallocation of avoidable expenditure toward improved disease control.
METHODS: A structured cost-of-non-control analysis was conducted over a 1-year horizon. Direct costs (maintenance and rescue pharmacotherapy, follow-up consultations, and exacerbations) used public institutional acquisition prices (CNIS). Comparative effectiveness for SITT (beclomethasone/formoterol/glycopyrronium) versus dual ICS/LABA was obtained from published phase 3 randomized controlled trial evidence, applying consistent exacerbation rates across comparators. Costs were reported in 2026 MXN and USD (17.53 MXN/USD), with probabilistic sensitivity analysis using gamma distributions.
RESULTS: Adults uncontrolled on dual ICS/LABA incurred an estimated annual direct cost of USD $4,732-$4,818 per patient, of which exacerbations accounted for approximately 94%—confirming poor control, not maintenance pharmacotherapy, as the principal cost driver. Each moderate-to-severe exacerbation represented USD $2,163 in direct cost. SITT reduced exacerbations versus dual therapy (relative reduction ~15%; RR 0.85; p=0.0084; 95% CI −13.1% to −1.9%), corresponding to 1.84 versus 2.16 exacerbations per patient annually. This lowered the annual cost to USD $4,228 per patient with SITT, yielding avoided costs of USD $504-$589 per patient versus dual comparators. SITT was the dominant strategy—lower total cost and fewer exacerbations—across all comparators, as its higher maintenance-drug cost was more than offset by reduced exacerbation-related expenditure. Findings were consistent across probabilistic sensitivity analysis, supporting the robustness of SITT's dominant position.
CONCLUSIONS: The cost of uncontrolled asthma from a Mexican public payer perspective is substantial and largely preventable. Escalating eligible adults from ICS/LABA to single-inhaler triple therapy reduces exacerbations and represents a dominant strategy from the payer perspective, allowing reallocation of avoidable expenditure toward improved disease control.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE575
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)