OBJECTIVES: Symbicort SMART is a simplified asthma management approach where the same inhaler is used as maintenance and reliever medication. Symbicort SMART can therefore treat breakthrough symptoms with a rapid increase in controller medication. This analysis aims at assessing the cost-effectiveness of Symbicort SMART vs. traditional treatment with combination of inhaled corticosteroid and bronchodilator products in a Thai healthcare setting. METHODS:The cost-effectiveness analysis was conducted from the health care provider perspective. It was based on data from a 6-month, double-blind, multinational study in which 3321 symptomatic asthma patients were randomised to: budesonide/formoterol B/F 160/4.5 μg bid plus further doses as needed; B/F 320/9 μg bid plus terbutaline prn (T); or salmeterol/fluticasone S/F 25/125 μg 2 inhalations bid plus T (P Kuna et al. Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract 2007; 61, 5:725-736). Thai unit costs were collected from national references and expert opinion and applied to the resource use data in a deterministic economic evaluation. The effectiveness variable was the No. of exacerbations/pt/6 months. RESULTS: There were fewer exacerbations in the Symbicort SMART group (0.12) vs. B/F 320/9 μg group (0.16; p<0.01) and vs. S/F (0.19; p<0.001). Total healthcare costs were 27% and 5.9% lower in the SMART group than in B/F 320/9 μg and S/F groups respectively. Drugcost/pt/6 months were 5461, 7561 and 5666 Baht. CONCLUSIONS: Symbicort SMART appears to be an attractive asthma treatment option for healthcare providers in Thailand as it reduces exacerbations and provides direct healthcare cost-savings as compared with traditional treatments with combination products.