OBJECTIVES: To investigate the budget impact in France of bronchial thermoplasty (BT) as add-on to standard care (BT-SC) compared to omalizumab as add-on to standard care (O-SC) and to standard care (SC) alone in the treatment of patients with severe asthma who fail intense pharmacological treatment. METHODS: Clinical outcomes were modelled (Markov model) in a cohort of uncontrolled, severe asthma patients over 5 years. BT is given as a course of 3 sessions during the 1^st year. Costs were allocated on the basis of French standard health costs. Four cost scenarios were examined, varying the cost of BT, the burden of hospital stays and the extent of healthcare consumption. RESULTS: In the scenario with lowest total cost of BT and lowest healthcare consumption, per capita costs over the 1^st year in BT-SC were € 14,016 higher than in SC, but € 3,356 lower than in O-SC. From the 2^nd year onward, BT-SC would generate an annual per capita saving of € 208 compared to SC and of € 17,771 compared to O-SC. In the scenario with highest total cost of BT and highest healthcare resource utilization, the excess cost associated with BT-SC during the 1^st year was € 17,273 and the cost saving for years 2-5 compared to SC was € 735/year. When extrapolated to all adult patients with uncontrolled severe asthma in France (16,651 individuals; 10% treated by BT-SC, 2.5% by O-SC and 87.5% with SC), the budget impact of introduction of BT would be savings of € 9,758,566 to € 16,390,259, depending on the cost scenario. CONCLUSIONS: Introduction of BT for patients with severe uncontrolled asthma would generate cost savings in the French setting.