Cost-effectiveness of inhaled corticosteroids in adults with mild-to-moderate asthma: Results from the Asthma Policy Model

A. D. Paltiel, A. L. Fuhlbrigge, B. T. Kitch, B. Liljas, S. T. Weiss, P. J. Neumann, K. M. Kuntz

Research output: Contribution to journalArticle

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Background: Inhaled corticosteroids remain underused among United States-based clinicians in treating mild-to-moderate adult asthma. Objective: The purpose of this investigation was to estimate the clinical impact, health-related quality of life, cost, and cost-effectiveness of inhaled corticosteroid therapy in a population of patients aged 18 years and over with FEV1 = 60% to 100% of predicted normal. Methods: We performed a cost-effectiveness analysis of quick relievers (eg, short-acting β-agonists) on an as-needed basis plus inhaled corticosteroid therapy versus quick relievers alone. A mathematical simulation model was developed to forecast symptoms, acute exacerbations, quality-adjusted life-years (QALYs), health care costs, and cost-effectiveness, measured in both dollars per QALY gained and dollars per symptom-free day gained. All evaluation outcomes were discounted at an annual rate of 3% and measured over a 10-year planning horizon. Data on the natural history of disease, drug efficacy, patient preferences, and economic costs were obtained from a variety of observational cohorts, randomized trials, and patient surveys. Results: Over a 10-year period, use of inhaled corticosteroids increases total health costs from roughly $5,200 to $8,400 and improves QALYs from 6.8 to 7.0, implying an incremental cost of $13,500 per QALY gained. Costs per symptom-free day gained are $7.50. Both per-person acute exacerbations and hospitalizations are reduced by 33%. The cost-effectiveness findings are sensitive to the assumed efficacy and side-effects of inhaled corticosteroid therapy. Conclusions: Inhaled corticosteroids appear to deliver good comparative value in adults with mild-to-moderate asthma. Although more research is needed to understand their impact on preferences regarding side effects and compliance, these findings might be useful for priority-setting in limited resource situations.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Issue number1
StatePublished - Jan 1 2001


  • Asthma
  • Cost-effectiveness analysis
  • Decision analysis
  • Inhaled corticosteroids
  • Markov models

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