title: Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma.
abstract: 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 >or=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 dollars 0.42 (SE, dollars 0.04) per day, and the resultant cost-effectiveness ratio was US dollars 11.30 (95% CI, US dollars 8.60-US dollars 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 US dollars 0.14 (SE, US dollars 0.07) per day and decreased the cost-effectiveness ratio to US dollars 3.70 (95% CI, US dollars 0.10-US dollars 8.00). Early intervention was more effective and cost saving in the youngest age group.
  
  
  CONCLUSIONS
  Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset.
authors.affiliation: Department of Pharmacy and Health Services, University of Washington, Seattle, Washington 98195-7630, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Martin
authors.initials: M
authors.lastname: Buxton
authors.forename: L Fredrik
authors.initials: LF
authors.lastname: Andersson
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Lamm
authors.forename: Bengt
authors.initials: B
authors.lastname: Liljas
authors.forename: Yu Zhi
authors.initials: YZ
authors.lastname: Chen
authors.forename: Romain A
authors.initials: RA
authors.lastname: Pauwels
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D019819:Budesonide / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D019819:Budesonide