An economic evaluation of combination treatment with budesonide and formoterol in patients with mild-to-moderate persistent asthma

Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose, adding a long-acting beta2-agonist, or both. This study assessed the cost-effectiveness of these options. Patients aged > or = 12 years with mild-to-moderate persistent asthma (n = 1272) were randomised to twice-daily, double-blind treatment with budesonide 100 microg, budesonide 100 microg plus formoterol 4.5 microg, budesonide 200 microg, or budesonide 200 microg plus formoterol 4.5 microg for 12 months. Clinical variables included lung function, number of symptom-free days and number of severe exacerbations. Data on medication use, hospitalisation, visits to health professionals and time off work due to asthma were combined with Swedish unit cost data (1999) to estimate the mean annual cost per patient. Budesonide 200 microg plus formoterol 4.5 microg had the greatest efficacy and effectiveness. Budesonide 200 microg plus formoterol 4.5 microg was both more effective and less costly than budesonide 100 microg plus formoterol 4.5 microg, so a cost-effectiveness ratio was not calculated for this comparison. The cost-effectiveness ratio for budesonide 200 microg plus formoterol 4.5 microg compared with budesonide 200 microg alone was SEK 21 per symptom-free days gained. The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost.