Cost-effectiveness of as-needed use of short-acting ß2-agonists plus inhaled corticosteroids in pediatric patients with mild intermittent asthma
Published: March 4, 202
Childhood asthma is a major public health problem in most countries of the world. Management of children with mild intermittent asthma is challenging in part since that treatment in these children is generally directed only at symptoms, despite asthma being a disease with a highly variable activity level that is driven by chronic airway inflammation. Given this challenge, as-needed use of an inhaled corticosteroids plus a short-acting ß2-agonist combination is as an attractive potential treatment strategy.
Rodríguez-Martínez et al. in a recent issue of The Journal of Allergy and Clinical Immunology: In Practice conducted a cost-effectiveness analysis in which they compared the use of albuterol alone to the use of beclomethasone dipropionate, an inhaled corticosteroid, added to albuterol as needed for symptoms relief in children 5–11 years old with mild intermittent asthma living in Colombia, a middle-income country. The main outcome of the cost-effectiveness model was a first course of prednisone for an asthma exacerbation. The study was carried out from the perspective of the national healthcare system in Colombia. Costs were calculated in Colombian pesos (COPs) and converted to dollars (US$s) based on the average exchange rate for 2018. Sensitivity analyses were performed to assess the robustness of the results.
The authors found that when compared to the use of albuterol alone, the use of beclomethasone dipropionate added to albuterol as needed for symptoms relief is cost-effective in children 5–11 years old with mild intermittent asthma. This is because it involved a higher probability of a lack of a requirement for a first course of prednisone for an asthma exacerbation (0.6500 vs. 0.5100), at lower total treatment costs (US$17.99 vs. US$27.94 mean cost per patient). The results were robust to sensitivity analyses.
The use of inhaled corticosteroids added to albuterol as needed for symptom relief could help to ensure more efficient management of asthma in children 5–11 years old with mild intermittent asthma. Although demonstrating the cost-effectiveness of an intervention for treating asthma in pediatric patients is certainly important, it is even more so in low- and middle-income countries, given the greater clinical and economic burden of the pediatric asthma in these countries when compared to high-income countries.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.