Pharmacoeconomic evaluation of ICS-LABA therapy in pediatric asthma: a cost-effectiveness and cost-utility analysis
1Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
For pediatric asthma, multiple inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) therapies are more cost-effective long-term than single-inhaler options, especially for severe cases. Single-inhaler therapies are viable for milder conditions.
Area of Science:
- Pharmacoeconomics
- Pediatric Pulmonology
- Health Services Research
Background:
- Asthma is a prevalent chronic respiratory condition in children globally.
- Inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combination therapies are standard for pediatric asthma management.
- The economic feasibility, specifically cost-effectiveness and cost-utility, of these regimens in pediatric asthma is under-researched.
Purpose of the Study:
- To evaluate the clinical efficacy of multiple ICS-LABA therapies versus single-inhaler therapies in pediatric asthma.
- To assess the cost-effectiveness and cost-utility of these treatment strategies in children aged 0-18 years.
- To provide pharmacoeconomic insights for optimizing pediatric asthma management and resource allocation.
Main Methods:
- Retrospective study of 59 pediatric asthma patients, divided into single-inhaler (Group A) and multiple-inhaler (Group B) therapy groups.
- Clinical efficacy measured by symptom-free periods; pharmacoeconomic analysis focused on direct medical costs.
- Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) employed, using willingness-to-pay (WTP) thresholds based on China's per capita GDP.
Main Results:
- Multiple-inhaler regimens, particularly triple therapy, demonstrated superior long-term cost-effectiveness and cost-utility for complex/extended pediatric asthma treatment.
- Single-agent therapies were more economically manageable for shorter-term, less severe asthma, with budesonide-formoterol showing better cost-effectiveness than salmeterol-fluticasone.
- Cost-utility analysis using Quality-Adjusted Life Years (QALYs) confirmed the cost-effectiveness of multiple inhaler regimens for prolonged pediatric asthma treatment.
Conclusions:
- Multiple ICS-LABA therapies, especially triple therapy, offer better long-term cost-effectiveness for severe pediatric asthma.
- Single-inhaler therapy remains economically viable for milder pediatric asthma cases.
- Findings support individualized treatment approaches and optimized healthcare resource allocation in pediatric asthma management.
Background:
Asthma is a chronic condition affecting children worldwide, with inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combination therapies widely used in its management. However, the economic feasibility of these treatment regimens in pediatric asthma, particularly from a cost-effectiveness and cost-utility perspective, remains understudied. This retrospective study aimed to evaluate the clinical efficacy, cost-effectiveness, and cost-utility of multiple ICS-LABA therapy compared to single-inhaler therapy in children aged 0-18 years with asthma.
Methods:
A total of 59 pediatric patients diagnosed with asthma were included, divided into two main groups: the single-inhaler therapy group (Group A) and the multiple-inhaler regimens group (Group B). Group A consisted of subgroups A1 (salmeterol-fluticasone) and A2 (budesonide-formoterol), while Group B included subgroups B1 (two inhaled medications) and B2 (three inhaled medications). Clinical efficacy was measured based on symptom-free periods, while pharmacoeconomic analysis was conducted from the perspective of direct medical costs, including medication and non-medication costs. Both cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were employed, with outcomes presented as cost-effectiveness ratios (C/E), incremental cost-effectiveness ratios (ICER), and incremental cost-utility ratios (ICUR), using the willingness-to-pay (WTP) threshold of three times the per capita GDP of China.
Results:
The study found that while the total medication costs for multiple-inhaler regimens were higher than for single-inhaler therapies, the long-term cost-effectiveness and cost-utility favored multiple-inhaler regimens, especially triple regimens (Group B2) in complex and extended treatment scenarios. Shorter-term, less severe conditions were more economically manageable with single-agent therapies, with budesonide-formoterol (A2) showing superior cost-effectiveness over salmeterol-fluticasone (A1). Cost-effectiveness ratios (C/E) and incremental cost-effectiveness ratios (ICER) supported these findings. The cost-utility analysis, using QALYs, confirmed that multiple inhaler regimens were more cost-effective in children requiring prolonged treatment.
Conclusion:
This study provides important pharmacoeconomic insights into the treatment of pediatric asthma, highlighting the trade-offs between treatment costs and clinical outcomes. For children with more severe asthma, multiple ICS-LABA therapies, particularly triple therapy, offer better cost-effectiveness in the long term, while single-inhaler therapy remains economically viable for milder conditions. These findings support a stratified, individualized treatment approach and provide evidence for optimizing healthcare resource allocation in pediatric asthma management.
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