title: Cost-utility analysis of daily versus intermittent inhaled corticosteroids in mild-persistent asthma.
abstract: BACKGROUND
  Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies.
  
  
  METHODS
  A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs).
  
  
  RESULTS
  For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US$437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant.
  
  
  CONCLUSIONS
  The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs.
authors: Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.|Research Unit, Military Hospital of Colombia, Bogota, Colombia.
authors: Carlos E
authors: CE
authors: Rodriguez-Martinez
authors: Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology, Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, District of Columbia.
authors: Gustavo
authors: G
authors: Nino
authors: Department of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors: Jose A
authors: JA
authors: Castro-Rodriguez
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
chemical_list: D005938:Glucocorticoids
keywords: asthma; cost-effectiveness; developing countries; inhaled corticosteroids; quality-adjusted life years