OBJECTIVES: To measure cost-effectiveness of the two most commonly used inhaled corticosteroids in asthma: Pulmicort Turbuhaler? (budesonide) and Flixotide Diskhaler? (fluticasone propionate). METHODS: A prospective health economics analysis was conducted in an 8-week, open, randomised, parallel-group trial comparing three treatment strategies: budesonide dry-powder inhaler 400 ?g/day (BUD400), fluticasone propionate dry-powder inhaler 400 ?g/day (FP400) and budesonide dry-powder inhaler 1600 ?g/day (BUD1600). 557 patients from Switzerland (CH), the Netherlands (NL) and Italy (I) participated. Health care costs and effectiveness were analysed in a cost-minimisation analysis with a third-party payer perspective. Effectiveness was measured as symptom-free days (SFD). Pooled resource consumption was analysed with the three countries’ prices in one analysis each. The health economics analysis included BUD400 and FP400, while the BUD1600 alternative was viewed as a reference arm in the clinical study. RESULTS: The percentage of SFD was 54.1 for BUD400 and 58.9 for FP400 (NS). The 8-week health care costs per patient were 60 (CH, p<0.01), 38 (NL, p<0.01), and 49 (I, p<0.01) percent lower for BUD400 than for FP400. Recalculated to US Dollars, this is equivalent to a lower 8-week health care cost of USD 142.53 (CH), USD 30.31 (NL), and USD 45.11 (I), respectively for the BUD400 treatment. CONCLUSIONS: Budesonide was a more cost-effective treatment alternative than fluticasone, since the cost was significantly lower for the budesonide treatment in all 3 countries studied, with no significant difference in effect.