A cost-utility analysis of single maintenance and reliever (SMART) therapy as compared to step 3 fixed-dose therapy in patients aged 12 years or more with uncontrolled asthma
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Date
2024
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Abstract
ObjectivesA significant percentage of patients with asthma appear to benefit from the addition of long-acting beta 2-agonists (LABAs) to ICS to achieve better control of their disease. The aim of the present study was to determine the cost-utility of single inhaler combination inhaled ICS/LABAs as both maintenance and reliever (SMART) versus remaining at the same treatment step with fixed-dose ICS-LABA maintenance with a short-acting beta 2-agonist (SABA) as reliever in patients aged 12 years or more with uncontrolled asthma.MethodsA Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from a recent meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs).ResultsThe base-case analysis showed that compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART was associated with lower costs, US$2,906.92 versus $4,462.02 average cost per patient, and the greatest gain in QALYs, 0.8540 versus 0.8258 QALYs on average per patient, thus leading to dominance.ConclusionsCompared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART is more cost-effective in patients aged 12 years or more with uncontrolled asthma. This is because ICS/LABAs as SMART showed a greater gain in QALYs at lower total treatment costs.
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combination of corticosteroid and long-acting beta 2 agonists, cost-effectiveness, persistent asthma, quality-adjusted life-years, sMART therapy