Cost-utility analysis of the inhaled steroids available in a developing country for the management of pediatric patients with persistent asthma

J Asthma. 2013 May;50(4):410-8. doi: 10.3109/02770903.2013.767909. Epub 2013 Mar 5.


Introduction: The choice among the different treatments available can have a great impact on the costs of asthma,

Objectives: The objective of this study was to estimate the incremental cost-utility ratio of three inhaled corticosteroids (ICs): budesonide (BUD), fluticasone propionate (FP), and ciclesonide, compared to beclomethasone dipropionate (BDP) (the only IC included in the Compulsory Health Insurance Plan of Colombia),

Methods: A Markov-type model was developed to estimate costs and health outcomes of a simulated cohort of patients less than 18 years of age with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from a hospital´s bills and from the national manual of drug prices. The study assumed the perspective of the national healthcare in Colombia. The main outcome was the variable "quality-adjusted life years" (QALY), RESULTS: While treatment with BDP was associated with the lowest cost (£106.16 average cost per patient during 12 months), treatment with FP resulted in the greatest gain in QUALYs (0.9325 QALYs). FP was associated with a greater gain in QALYs compared to BUD and ciclesonide (0.9325 vs. 0.8999 and 0.9051 QALYs, respectively) at lower costs (£231.19 vs. £309.27 and £270.15, respectively), thus leading to dominance. The incremental cost-utility ratio of FP compared to BDP was £19,835.28 per QALY, CONCLUSIONS: BDP is the most cost-effective therapy for treating pediatric patients with persistent asthma when willingness to pay (WTP) is less than £21,129.22/QALY, otherwise, FP is the most cost-effective therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / economics
  • Adrenal Cortex Hormones / therapeutic use*
  • Androstadienes / economics
  • Androstadienes / therapeutic use
  • Anti-Asthmatic Agents / economics*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / economics*
  • Beclomethasone / economics
  • Beclomethasone / therapeutic use
  • Budesonide / economics
  • Budesonide / therapeutic use
  • Child
  • Cohort Studies
  • Colombia
  • Computer Simulation
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Fluticasone
  • Humans
  • Male
  • Markov Chains
  • Models, Economic
  • Pregnenediones / economics
  • Pregnenediones / therapeutic use
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic


  • Adrenal Cortex Hormones
  • Androstadienes
  • Anti-Asthmatic Agents
  • Pregnenediones
  • Budesonide
  • Fluticasone
  • Beclomethasone
  • ciclesonide