OBJECTIVES: To compare cost and utility of asthma treatment with fixed combinations ICS+LABA Salmeterol + Fluticasone (SAL/FP maintainance treatment) vs. Budesonide+Formoterol (BUD/FOR in both maintenance and rescue treatment). METHODS: OPTIMA model includes 4 steps-by-step sub-analyses of 1- drugs cost, 2- cost and utility (quality of life; QoL) with controlled and uncontrolled asthma, 3- proportion of controlled and uncontrolled asthma achieved by using comparators, 4- total cost, saving and utility. In this analysis we used: average drugs prices and drugs dosage proportion sold in reimbursement in 2008 from Farmexpert market monitoring; number of inhalations per day data was derived from instruction and published study (Johansson G. et al. 2006) for SAL/FP and Budesonide+Formoterol, respectively; QoL and number of resources with controlled and uncontrolled asthma was derived from doctoral dissertation of  Demko I.V. 2007; resources unit-cost from government regulation on 2009 health care insurance program; work-off day cost included tax deficiency, GDP underproduction and sick pay; frequency of controlled asthma from clinical trials (assumption: for Budesonide+Formoterol we used maximal published % of asthma-control days because of no data on % of asthma-control). Core formula of analysis is: cost of drug + % controlled * cost of controlled + % uncontrolled * cost of uncontrolled. RESULTS: Average monthly cost of drugs were 1672 Rub and 1458 Rub (~ €40 EUR and €35) for SAL/FP and BUD/FOR, respectively. Cost and QoL and were 320 Rub (~ €8) and 0.75 in controlled and 62,753 Rub (€1400) and 0.49 in uncontrolled asthma. Drugs allow to achieve asthma-control in 75% (GOAL study) and 47.4% (see assumption), respectively. Total cost were 35,991 Rub and 50,654 Rub; utility were 0.69 and 0.613 for SAL/FP and BUD/FOR, respectively. CONCLUSIONS: Total cost in SAL/FP arm is lower than in BUD/FOR, but utility is higher. Therefore, SAL/FP is the dominating alternative.