Introduction: In budesonide/formoterol (Symbicort® Turbuhaler®, AstraZeneca, Lund, Sweden) maintenance and reliever therapy (SMART), patients with asthma take a daily maintenance dose of budesonide/formoterol, with the option of taking additional doses for symptom relief instead of a short-acting β2-agonist (SABA). This study assesses the cost-effectiveness of SMART compared with usual care in patients with mild-to-moderate persistent asthma treated by general practitioners in the Netherlands from a societal perspective. Methods: The study was linked to a randomized, active-controlled, open-label, multicenter, 12-month clinical trial, with a prospective collection of resource use. One hundred and two patients ≥18 years with mild-to-moderate persistent asthma and daily inhaled corticosteroids (ICS) prior to the trial were included. SMART was given as two inhalations of budesonide/formoterol (100/6 μg) once daily, plus additional doses as needed. The control group was treated according to guidelines, which prescribe medium daily doses of ICS plus an SABA if needed. A long-acting β2-agonist (LABA) is added if necessary. Effectiveness was measured as the proportion of asthma-control days, Asthma Control Questionnaire (ACQ) scores, the net proportion of patients with relevant ACQ improvement, and the proportion of well-controlled patients. Costs included asthma medication, physician contacts, and absence from work. Results: Mean total costs for SMART were €134.81 lower (95% CI: -€439.48; €44.85). Production losses were €94.10 (95% CI: -€300.60; €0.29) lower for SMART (€10.77 vs. €104.87). No significant differences in health outcomes were seen, with 3.81 fewer asthma-control days per patient-year for SMART (95% CI: -36.8; 30.8), a 0.049 better ACQ score (95% CI: -0.21; 0.29), a 5.8% larger net proportion of improved patients (95% CI: t15.6%; 27.3%), and a 2.1% (95% CI: -25.5; 20.8%) smaller increase in the proportion of well-controlled patients. Conclusions: Treating primary care patients with mild-to-moderate persistent asthma with SMART instead of ICS plus bronchodilators does not affect health outcomes and does not increase costs; therefore, is likely to be an alternative for guideline-directed treatment, from a health and economic perspective.

Symbicort, asthma, budesonide/formoterol, cost-effectiveness, inhaled corticosteroid,
Advances in Therapy: the international journal of drug, device and diagnostic research
Erasmus MC: University Medical Center Rotterdam

Goossens, L.M.A, Riemersma, R.A, Postma, D.S, van der Molen, T, & Rutten-van Mölken, M.P.M.H. (2009). An economic evaluation of budesonide/formoterol for maintenance and reliever treatment in asthma in general practice. Advances in Therapy: the international journal of drug, device and diagnostic research, 26(9), 872–885. doi:10.1007/s12325-009-0063-0