Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy

David Brendan Price* (Corresponding Author), A. Wirén, P. Kuna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)


Background: Budesonide/formoterol (Symbicort((R))) Maintenance and Reliever Therapy (SMART) is an effective asthma-management approach that treats symptoms with rapid increases in budesonide/formoterol. The cost-effectiveness of SMART vs higher fixed-dose budesonide/formoterol or salmeterol/fluticasone is unknown.

Methods: This 6-month, double-blind study randomized patients with asthma uncontrolled by inhaled corticosteroids alone (n = 3335; age >= 12 years) to budesonide/formoterol 160/4.5 mu g b.i.d. plus additional doses as needed (SMART), budesonide/formoterol 320/9 mu g b.i.d. plus as-needed terbutaline, or salmeterol/fluticasone 50/250 mu g b.i.d. plus as-needed terbutaline. Economic analysis, assuming health care and societal perspectives, applied 2004 UK and Australian unit costs to pooled resource-use data. The effectiveness variable was the rate of severe exacerbations/patient/6 months.

Results: Patients treated using the SMART approach experienced fewer severe exacerbations than fixed-dose budesonide/formoterol and  salmeterol/fluticasone patients (0.12 vs 0.16 and 0.19 events/patient/6 months, respectively; P <= 0.0048). Budesonide/formoterol (Symbicort((R))) Maintenance and Reliever Therapy provided similar improvements in other markers of asthma control at a lower overall daily inhaled corticosteroid dose compared with fixed-dose treatment. Study drug costs accounted for a majority of both direct costs (DC; 78-87%) and total costs (TC; 50-63%) for all treatments, and were significantly lower in the SMART group compared with the fixed-dose groups (P <= 0.0014). Direct and TC per patient/6 months were lower for SMART vs salmeterol/fluticasone (DC:-AUS$154, P < 0.0001; TC:-AUS$163, P = 0.0036;-87 pound, P = 0.0026) and vs budesonide/formoterol using UK costs (DC:-73 pound, P < 0.0001; TC:-91 pound, P = 0.0014). Costs tended to be lower for SMART vs budesonide/formoterol using Australian costs (DC:-AUS$35, P = 0.16; TC:-AUS$70, P = 0.20). Results were stable under sensitivity testing. Indirect resource use and cost were not significantly different between groups.

Conclusion: Compared with higher fixed-dose budesonide/formoterol and salmeterol/fluticasone, SMART reduces the incidence of severe exacerbations at a lower or similar overall cost and can be considered a cost-effective treatment regimen.

Original languageEnglish
Pages (from-to)1189-1198
Number of pages10
Issue number10
Early online date5 Sep 2007
Publication statusPublished - Oct 2007


  • asthma
  • budesonide/formoterol
  • cost effectiveness
  • salmeterol/fluticasone
  • budesonide/formoterol (Symbicort (R)) Maintenance and Reliever Therapy
  • Maintenance and Reliever Therapy


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