OBJECTIVES: Asthma is a heterogeneous disease characterized by airways inflammation. Daily inhaled corticosteroid (ICS) with a long-acting beta-agonist (LABA) plus short-acting beta-agonist (SABA) as reliever is the standard of care (SoC) in Panama for moderate asthma. Single inhaler combination budesonide–formoterol (Bud-Form) as both maintenance and reliever therapy (SMART) is more effective than ICS-LABA combination plus SABA as reliever in reducing oral corticosteroids use, emergency room (ER) visits and hospitalizations; however, in Panama the information on the budget impact of the efficacy of SMART in patients with moderate asthma is unknow.

METHODS: A model comparing Bud-Form SMART vs. daily ICS+LABA (in separate devices) plus SABA as reliever therapy (SoC) was performed. Data was based on treatment-related outcomes from published clinical trials and drugs, ER visits, and hospitalizations from an advisory board with local pulmonologists. A market share for SMART of 2% first year, 10% second year, and 15% third year; was assumed. The currency was American dollars (USD). Costs per inhaler: Bud-Form 160/4,5µg, $29,14; beclomethasone 100µg, $2,00; formoterol 12µg, $39,39; and salbutamol 100µg, $1,00. Salbutamol and beclomethasone have 200 doses, Bud-Form has 120 doses, and formoterol has 60 doses. Mean number of inhalations: SMART=2.52 inhalations/day, beclomethasone=6 inhalations/day; formoterol=2 inhalations/day; and salbutamol=2.53 inhalations/day. Adherence of 100% for all treatments was assumed. A population of 83.849 patients in the first year; 88.776 second year; and 94.100 third year was assumed. Relapsing average costs are $655 for an ER visit and $1.263 for a hospitalization.

RESULTS: Bud-Form SMART saves $90.192 first year (-0,37%), $515.560 second year (-1.86%) and $871.312 third year (-2,80%). The savings are directly proportional to the market share of patients using SMART.

CONCLUSIONS: In Panama, the total budget impact over three years due to the introduction of Bud-Form SMART was $1’477.064 less expensive than SoC in patients with moderate asthma.