OBJECTIVES: Asthma is a heterogeneous disease characterized by airways inflammation. Daily inhaled corticosteroid (ICS) plus short-acting beta-agonist (SABA) as reliever is the standard of care (SoC) in Costa Rica for mild asthma. Anti-inflammatory reliever (AIR) therapy with budesonide–formoterol (Bud-Form) as needed is at least as effective as ICS monotherapy plus SABA as reliever in reducing oral corticosteroids use, emergency room [ER] visits and hospitalizations; however, in Costa Rica the information on the budget impact of the efficacy of AIR in patients with mild asthma is unknow.

METHODS: A model comparing Bud-Form as needed vs. daily ICS 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, $28,37; beclomethasone 100µg, $2,37; fluticasone propionate 250µg, $22,80; budesonide 200µg, $9,07; and salbutamol 100µg, $1,25. All inhalers have 120 inhalations, except beclomethasone and salbutamol, which have 200. All ICS need two inhalations/day; mean number of inhalations: Bud-Form as needed=0.52 inhalations/day and salbutamol=0,98 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 $645 for an ER visit and $1.244 for a hospitalization.

RESULTS: Bud-Form as needed saves $15.700 first year (-0,3%), $83.471 second year (-1,7%) and $132.717 third year (-2,6%). The savings are directly proportional to the market share of patients using AIR therapy.

CONCLUSIONS: In Costa Rica, the total budget impact over three years due to the introduction of Bud-Form as needed was $231.888 less expensive than SoC in patients with mild asthma.