As-Needed Use of Short-Acting β2-Agonists Alone Versus As-Needed Use of Short-acting β2-Agonists Plus Inhaled Corticosteroids in Pediatric Patients With Mild Intermittent (Step 1) Asthma: A Cost-Effectiveness Analysis

This study aimed to compare the cost-effectiveness of using a short-acting β2-agonist (SABA) alone versus using SABA plus inhaled corticosteroids (ICS) on an as-needed basis in children with mild intermittent asthma experiencing an exacerbation of symptoms.

The study population consisted of children aged 5 to 11 years of age with mild intermittent asthma. Inclusion criteria included being naive to controller treatment, having a history of 1 to 2 exacerbations in the previous year, and treatment over the previous 8 weeks either with non-ICS monotherapy or low-dose corticosteroids.

Exclusion criteria were an forced expiratory volume 1 <60% predicted at the first visit, >2 exacerbations or hospital admission for asthma in the previous year, an exacerbation in the past 3 months, or a history of life-threatening asthma exacerbation.

A decision-analysis model was adapted, utilizing effectiveness parameters from a randomized clinical trial. Cost data were obtained from hospital bills and the national manual of drug prices in Colombia.

The as-needed use of SABA plus ICS was associated with lower overall treatment costs (mean cost per patient: $17.99), compared with the use of SABAs alone (mean cost per patient: $27.94). Additionally, the use of SABAs plus ICS demonstrated a higher probability of not requiring a first course of prednisone for an asthma exacerbation (0.65), compared with SABAs alone (0.51).

In children aged 5 to 11 years with mild intermittent asthma in Colombia, adding beclomethasone dipropionate to albuterol, as needed for symptom relief, was found to be cost-effective. This combination treatment resulted in a higher probability of avoiding the need for prednisone for an asthma exacerbation at lower total treatment costs, making it an advantageous approach in this population.

There is considerable debate surrounding the best treatment approach for children with mild intermittent asthma (Step 1), with recent studies supporting the efficacy of as-needed use of ICS in conjunction with SABA, also known as single maintenance and reliever therapy. This study supports the cost effectiveness of as-needed use of SABA plus ICS in comparison with SABA alone in a pediatric population. This provides additional support for the Global Initiative for Asthma 2021 asthma guidelines for children, which offers SABA plus ICS as a valid option. However, this study occurred in the context of the Colombian national healthcare system, limiting its applicability to the American healthcare system.