OBJECTIVES: To estimate the cost-effectiveness of the bronchial thermoplasty (BT) in Mexico, Colombia and Spain, based on the number of asthmatic exacerbations avoided and using the best available scientific evidence. METHODS: We designed a Markov model to project a hypothetical cohort of adult patients with severe, persistent and uncontrolled asthma. We calculated the incremental cost-effectiveness ratio (ICER) of the BT and conventional pharmacological scheme (BT+CFE; fluticasone plus salmeterol) in comparison with omalizumab and CFE (OMAL+CFE). Alternatives were considered cost-effective when the ICER was equivalent or below the value of three gross domestic product (GDP) per capita (pp) per exacerbation avoided, and very cost-effective when the value was below the value of one GDP pp per exacerbation avoided. Parameters describing the consumption of health services were obtained from a local panel of experts, costs were based on local and official information, all costs are expressed as 2017 value of the United States dollars. Clinical parameters from meta-analysis, randomized clinical trials and indirect comparisons were leveraged. A time horizon of 5 years was used and sensitivity analyses were estimated with Monte Carlo simulations. The analysis leveraged TreeAge™ Software. RESULTS: Compared to CFE, in Mexico, we project BT+CFE has an ICER of $3,738 per avoided exacerbation; for Colombia, the ICER is $2,732; in Spain, an ICER of $3,060; all previous BT+CFE ICERs were classified as very cost-effective. In each of the three countries, we identified BT+CFE as the ‘dominant’ strategy compared to OMAL+CFE. CONCLUSIONS: In these three countries’ health care systems, BT is projected to provide a very cost-effective treatment, and estimated to likely be cost-saving compared to an alternative pharmacological treatment.