OBJECTIVES: To evaluate the cost-effectiveness of budesonide/formoterol combination therapy plus as need compared with salmeterol/fluticasone plus salbutamol as reliever therapy for asthma patients ≥12 years from the societal perspective.

METHODS: A Markov model was developed with three health states (i.e. non-exacerbation, exacerbation, and death) with a lifetime horizon. The exacerbation state was defined as asthma deterioration requiring for usage of oral corticosteroids for ≥ 3 days; or hospitalization/emergency room therapy; or hospitalization in combination with systemic corticosteroid use ≥ 3 days. The exacerbation rates were obtained from a prospective cohort study conducted among Chinese asthma patients. Healthcare resources utilization data were collected from the authoritative diagnosis and treatment guideline and had been validated by experienced clinical experts. Asthma-related mortality, cost inputs and utility values were derived from public database and the literature. Model robustness was assessed via one-way sensitivity and probabilistic sensitivity analyses.

RESULTS: Compared with salmeterol/fluticasone plus salbutamol, budesonide/formoterol led to fewer exacerbation events (9.64 vs 11.26), with an additional ¥742.49 total cost, less ¥3027.52 cost of exacerbation management, quality-adjusted life years (QALY) gains of 0.0077 over a lifetime horizon. The base case incremental cost-effectiveness ratio (ICER) was ¥37,123.50 per QALY gained. Key drivers were the price of budesonide/formoterol and salmeterol/fluticasone, treatment adherence, and exacerbation rates. At a willingness-to-pay of ¥85,698/QALY (1 times of GDP-per-capita in China), the probability of budesonide/formoterol maintenance and reliever therapy being cost-effective versus salmeterol/fluticasone plus as-needed salbutamol was 48.95%.

CONCLUSIONS: Overall, from the societal perspective, budesonide/formoterol is likely to be a cost-effective option compared with salmeterol/fluticasone plus as-needed salbutamol for Chinese asthma patients ≥12 years. Meanwhile, inclusion of broader evidence on treatment adherence and exacerbation from real-world studies among Chinese population is suggested, which could solidate the economic evidence and further improve the use of budesonide/formoterol.