Work

Cost-effectiveness of anti-inflammatory reliever (AIR) or maintenance and reliever therapy (MART) for mild to moderate asthma: a systematic review

Year: 2026

Type: review

Abstract: Background The Global Initiative for Asthma recommends inhaled corticosteroid (ICS)-formoterol as anti-inflammatory reliever (AIR) or as maintenance and reliever therapy (MART) for the management of all asthma severities based on evidence of superior clinical effectiveness. This systematic review aimed to collate available evidence of the cost-effectiveness of ICS-formoterol for mild to moderate asthma compared with bronchodilator and ICS, used separately or in combination, in adolescents and adults.Methods Systematic literature searches were conducted on MEDLINE/PubMed, Scopus, Web of Science, Cochrane and the first 150 records from Google Scholar. Studies comparing the cost-effectiveness of ICS-formoterol AIR/MART to short-acting beta-2 agonist (SABA), ICS and ICS-long-acting beta-2 agonist (LABA) (other than formoterol) inhalers in people with asthma aged 12 years and older were included. Reporting was done using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model.Results Six studies evaluated as moderate to high quality involving 8901 patients were included in the analysis. Three studies were from low- and middle-income countries and three from high-income countries. ICS-formoterol AIR/MART was cost-effective when compared with SABA, ICS plus SABA and ICS-LABA plus SABA. The cost difference of ICS-formoterol ranged from an additional cost of US$56 to a cost-saving of US$9900, with small quality-adjusted life-year (QALY) gains (0.001 to 0.0077) and exacerbation reductions (up to 2.33 fewer events).Conclusions The data suggest that ICS-formoterol AIR/MART is cost-effective for mild to moderate asthma. Due to cost-effectiveness thresholds being based on each country’s gross domestic product (GDP), more country-specific data, particularly from countries in Africa, is needed.PROSPERO registration number CRD42024517577.

Source: BMJ Open Respiratory Research

DOI: 10.1136/bmjresp-2026-004148

Authors: Nqobile Ndimande, Kevin Mortimer, Marie Stolbrink, Josue Mbonigaba, Nicola Marozva, Refiloe Masekela