Cost-effectiveness of as-needed budesonide-formoterol in adults with mild asthma: the Novel START trial
Year: 2025
Type: article
Abstract: Background The Global Initiative for Asthma recommends as-needed combination inhaled corticosteroid-formoterol reliever for mild asthma. Its cost-effectiveness is uncertain outside double-blind regulatory trials. The study objectives were to assess the cost-effectiveness of as-needed budesonide-formoterol versus maintenance budesonide plus as-needed salbutamol, and versus as-needed salbutamol, in averting exacerbations in adults with mild asthma during 12-month follow-up of the New Zealand participants (n=551) of the open-label Novel START multicountry clinical trial. Methods New Zealand health-system and societal perspectives were adopted using 2025 resource costs. Healthcare utilisation comprised electronically monitored inhaler use (with multiple imputation for missing data), asthma-related pharmaceuticals, primary-care visits, emergency-department visits and hospitalisations. Regression methods were used for cost-effectiveness analysis. Scenarios included generic substitution and prescription-charge exemption. Results As-needed budesonide-formoterol, compared with maintenance budesonide plus as-needed salbutamol, is more effective at reducing severe exacerbations and provides an annual health-system cost saving of NZD 12 (95% CI 0–28) per patient, increasing to NZD 22 (95% CI −15–58) if a societal perspective is adopted. Compared with as-needed salbutamol alone, as-needed budesonide-formoterol costs the health system NZD 38 and NZD 111, respectively, to prevent an exacerbation and a severe exacerbation. From a societal perspective it is cost-saving NZD 70 (95% CI 2–134). Findings were robust to scenario analyses. Conclusion For patients with mild asthma, as-needed budesonide-formoterol 200/6 μg is cost-saving from health-system, patient and societal perspectives, while improving outcomes, dominating maintenance budesonide plus as-needed salbutamol. Compared with as-needed salbutamol, as-needed budesonide-formoterol is cost-effective from a health-system perspective and dominates from a societal perspective.
Source: ERJ Open Research
Institutions: University of Auckland, Medical Research Institute of New Zealand, University of Otago, Woolcock Institute of Medical Research, Sydney Local Health District, Macquarie University, Cardiff University, Technical University of Applied Sciences Lübeck, AstraZeneca (United Kingdom), University of Nottingham, Nottingham Biomedical Research Centre, University of Oxford, Imperial College London, University of Ferrara, Health New Zealand, Waikato Hospital, Waikato District Health Board
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $808
OpenAlex ID: W4414612421