OBJECTIVES: Asthma is a heterogeneous disease characterized by airway inflammation. Daily inhaled corticosteroid (ICS) plus short-acting beta-agonist (SABA) as a 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 as effective as ICS monotherapy plus SABA as a reliever in reducing oral corticosteroid 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 unknown.

METHODS: We performed a model comparing Bud-Form as needed versus daily ICS plus SABA as reliever therapy (SoC). Data about treatment-related outcomes are from published clinical trials, and medicines exacerbations, ER visits, and hospitalizations are from an advisory board with local pulmonologists. The first-year market share for AIR is 2%, 10% in the second year, and 15% in the third year. Costs are in 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, with 200. All ICS need two inhalations/day; the mean number of inhalations: Bud-Form as needed=0.52 inhalations/day and salbutamol=0.98 inhalations/day. All treatments have an adherence of 100%. 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 the first year (-0.3%), $83,471 a second year (-1.7%), and $132,717 the 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.