# Pharmacoeconomic evaluation of ICS-LABA therapy in pediatric asthma: a cost-effectiveness and cost-utility analysis

## TL;DR

This study compares the cost-effectiveness of different ICS-LABA therapies for pediatric asthma, finding that multiple-inhaler regimens are more cost-effective for severe, long-term cases.

## Contribution

The study provides novel pharmacoeconomic insights into ICS-LABA therapies for pediatric asthma, particularly the long-term cost-utility of multiple-inhaler regimens.

## Key findings

- Multiple-inhaler ICS-LABA regimens showed better long-term cost-effectiveness and cost-utility for complex and extended treatment scenarios.
- Budesonide-formoterol (A2) was more cost-effective than salmeterol-fluticasone (A1) for shorter-term, less severe conditions.
- Cost-utility analysis confirmed that multiple inhaler regimens are more cost-effective for prolonged treatment in children.

## Abstract

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.

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.

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.

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.