Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma

Background: The Inhaled Steroid as Regular Therapy in Early Asthma (START) study reported that early intervention with budesonide in mild persistent asthma reduces severe asthmatic events and improves symptom outcomes and lung function in adults and children. Objective: We sought to estimate the incremental cost-effectiveness of early intervention with budesonide, as observed within the START study. Methods: START was a randomized, 3-year controlled trial of budesonide in early onset mild asthma among 7165 subjects ages 5 to 66 years. Three age groups (5-10, 11-17, and ≥18 years) were studied separately and overall. Differences in the probability of emergency treatments, symptom-free days (SFDs), and costs of health care were determined. Incremental cost-effectiveness ratios were estimated from the health care payer and societal perspectives. Results: Compared with usual therapy, patients receiving budesonide experienced an average of 14.1 (SE, 1.3) more SFDs per year (P < .001), fewer hospital days (69%, P < .001), and fewer emergency department visits (67%, P < .05). From the health care payer perspective, the net cost of early use of budesonide was an additional US$0.42 (SE, $0.04) per day, and the resultant cost-effectiveness ratio was $11.30 (95% CI, $8.60-$14.90) per SFD gained. From the societal perspective, the cost offsets of lower absence from school or work reduced the net cost of early budesonide to $0.14 (SE, $0.07) per day and decreased the cost-effectiveness ratio to $3.70 (95% CI, $0.10-$8.00). Early intervention was more effective and cost saving in the youngest age group. Conclusion: Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset.