OBJECTIVES: In the Brazilian public health care system, mometasone furoate (MF DPI) is not available and budesonide/formoterol (BUD/FF DPI) association is responsible for 86.9% of pharmacy claims for asthma. This study aimed to conduct cost-effectiveness and budget impact analysis (BIA) of MF versus BUD/FF for adult patients with mild to moderate asthma from the public payer perspective. METHODS: A decision tree was developed to compare MF and BUD/FF based on indirect comparison once head-to-head studies were not available. The final FEV1 values were converted into probabilities of hospitalization in the first two years in accordance with observational evidence of association between FEV1 and exacerbation requiring hospitalization. Only direct medical costs were considered and unit costs were obtained from Brazilian official lists. BIA assumed pharmacy claims data from the Ambulatory Information System as current scenario (Beclomethasone: 3.1%; BUD: 9.9%; BUD/FF: 86.9%) and a 20% initial market share for MF in substitution to equivalent doses of BUD/FF. RESULTS: Indirect comparison indicated 79 hospitalizations per 1000 patients for MF and 82 for BUD/FF during the first 2 years of treatment. Total cost of treatment was 832BRL and 655BRL per patient for MF200mcg twice a day (bid) and MF400mcg once a day and 840BRL for BUD/FF 400/12mcg bid. These findings indicated MF as cost-saving in the proposed scenario with ICER of -2.608BRL and -61.959BRL per avoided hospitalization for MF200mcg and MF400mcg, respectively. The estimated budgetary impact for the first year showed a saving of 259,346,480BRL for MF 400mcg and 10,919,299BRL for MF 200mcg. CONCLUSIONS: MF is a clinically effective option to treat mild to moderate asthma and indirect comparison showed its clinical and economic benefit when compared to the most used anti-asthma medication in the Brazilian public setting. Further research to directly compare both medications and to measure finalistic outcomes alongside clinical trials is needed.