, Volume 36, Issue 10, pp 1165–1200 | Cite as

Cost Effectiveness of Pharmacological Treatments for Asthma: A Systematic Review

  • Carlos E. Rodriguez-MartinezEmail author
  • Monica P. Sossa-Briceño
  • Jose A. Castro-Rodriguez
Systematic Review



The objective of this article was to summarize the findings of all the available studies on alternative pharmacological treatments for asthma and assess their methodological quality, as well as to identify the main drivers of the cost effectiveness of pharmacological treatments for the disease.


A systematic review of the literature in seven electronic databases was conducted in order to identify all the available health economic evidence on alternative pharmacological treatments for asthma published up to April 2017. The reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.


A total of 72 studies were included in the review, classified as follows: medications for acute asthma treatment (n = 5, 6.9%); inhaled corticosteroids (ICS) administered alone or in conjunction with long-acting β-agonists (LABA) or tiotropium for chronic asthma treatment (n = 38, 52.8%); direct comparisons between different combinations of ICS, ICS/LABA, leukotriene receptor antagonists (LTRA), and sodium cromoglycate for chronic asthma treatment (n = 14, 19.4%); and omalizumab for chronic asthma treatment (n = 15, 20.8%). ICS were reported to be cost effective when compared with LTRA for the management of persistent asthma. In patients with inadequately controlled asthma taking ICS, the addition of long-acting β-agonist (LABA) preparations has been demonstrated to be cost effective, especially when combinations of ICS/LABA containing formoterol are used for both maintenance and reliever therapy. In patients with uncontrolled severe persistent allergic asthma, omalizumab therapy could be cost effective in a carefully selected subgroup of patients with the more severe forms of the disease. The quality of reporting in the studies, according to the CHEERS checklist, was very uneven. The main cost-effectiveness drivers identified were the cost or rate of asthma exacerbations, the cost or rate of the use of asthma medications, the asthma mortality risk, and the rate of utilization of health services for asthma.


The present findings are in line with the pharmacological recommendations for stepwise management of asthma given in the most recent evidence-based clinical practice guidelines for the disease. The identified reporting quality of the available health economic evidence is useful for identifying aspects where there is room for improvement in future asthma cost-effectiveness studies.



The authors thank Mr. Charlie Barret for his editorial assistance.

Author Contributions

Dr. RM conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and approved the final version as submitted. Dr. SB critically reviewed and revised the manuscript, and approved the final version as submitted. Dr. CR carried out the initial analyses, reviewed and revised the manuscript, and approved the final version as submitted. All authors approved the final version of the manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with Ethical Standards

Conflicts of interest

Carlos E. Rodriguez-Martinez, Monica P. Sossa-Briceno, and Jose A. Castro-Rodriguez declare that they have no conflicts of interest.




  1. 1.
    Loftus PA, Wise SK. Epidemiology and economic burden of asthma. Int Forum Allergy Rhinol. 2015;5(Suppl 1):S7–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Ehteshami-Afshar S, FitzGerald JM, Doyle-Waters MM, Sadatsafavi M. The global economic burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis. 2016;20(1):11–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Castro-Rodriguez JA, Rodrigo GJ, Rodriguez-Martinez CE. Principal findings of systematic reviews of acute asthma treatment in childhood. J Asthma. 2015;52(10):1038–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Castro-Rodriguez JA, Rodrigo GJ, Rodriguez-Martinez CE. Principal findings of systematic reviews for chronic treatment in childhood asthma. J Asthma. 2015;52(4):407–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Lee TA, Weiss KB. An update on the health economics of asthma and allergy. Curr Opin Allergy Clin Immunol. 2002;2(3):195–200.PubMedCrossRefGoogle Scholar
  7. 7.
    Bahadori K, Quon BS, Doyle-Waters MM, Marra C, Fitzgerald JM. A systematic review of economic evaluations of therapy in asthma. J Asthma Allergy. 2010;3:33–42.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2006.Google Scholar
  9. 9.
    Campbell JD, Spackman DE, Sullivan SD. Health economics of asthma: assessing the value of asthma interventions. Allergy. 2008;63(12):1581–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Cheng JW, Arnold RJ. Pharmacoeconomic review of medical management of persistent asthma. Allergy Asthma Proc. 2008;29(2):109–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Dominguez-Ortega J, Phillips-Angles E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. J Asthma. 2015;52(6):529–37.PubMedCrossRefGoogle Scholar
  12. 12.
    Shepherd J, Rogers G, Anderson R, Main C, Thompson-Coon J, Hartwell D, et al. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over. Health technology assessment. 2008;12(19):iii–iv, 1–360.Google Scholar
  13. 13.
    Kim CH, Dilokthornsakul P, Campbell JD, van Boven JFM. Asthma cost-effectiveness analyses: are we using the recommended outcomes in estimating value? J Allergy Clin Immunol Pract. 2018;6(2):619–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Pharmacoeconomics. 2013;31(5):361–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Economic analysis of health care technology. A report on principles. Task Force on Principles for Economic Analysis of Health Care Technology. Ann Intern Med. 1995;123(1):61–70.CrossRefGoogle Scholar
  16. 16.
    Davis JC, Robertson MC, Comans T, Scuffham PA. Guidelines for conducting and reporting economic evaluation of fall prevention strategies. Osteoporos Int. 2011;22(9):2449–59.PubMedCrossRefGoogle Scholar
  17. 17.
    Drummond M, Manca A, Sculpher M. Increasing the generalizability of economic evaluations: recommendations for the design, analysis, and reporting of studies. Int J Technol Assess Health Care. 2005;21(2):165–71.PubMedGoogle Scholar
  18. 18.
    Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996;313(7052):275–83.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Nuijten MJ, Pronk MH, Brorens MJ, Hekster YA, Lockefeer JH, de Smet PA, et al. Reporting format for economic evaluation. Part II: focus on modelling studies. PharmacoEconomics. 1998;14(3):259–68.PubMedCrossRefGoogle Scholar
  20. 20.
    Petrou S, Gray A. Economic evaluation using decision analytical modelling: design, conduct, analysis, and reporting. BMJ. 2011;342:d1766.PubMedCrossRefGoogle Scholar
  21. 21.
    Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health. 2005;8(5):521–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276(16):1339–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Vintzileos AM, Beazoglou T. Design, execution, interpretation, and reporting of economic evaluation studies in obstetrics. Am J Obstet Gynecol. 2004;191(4):1070–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med. 2010;7(2):e1000217.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Andrews AL, Wong KA, Heine D, Scott Russell W. A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad Emerg Med. 2012;19(8):943–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Powell CV, Kolamunnage-Dona R, Lowe J, Boland A, Petrou S, Doull I, et al. MAGNEsium Trial In Children (MAGNETIC): a randomised, placebo-controlled trial and economic evaluation of nebulised magnesium sulphate in acute severe asthma in children. Health Technol Assess. 2013;17(45):v–vi, 1–216.Google Scholar
  27. 27.
    Rodrigo GJ, Rodrigo C. Cost effectiveness of the application of inhaled ipratropium bromide in the treatment of adult patients with acute asthma in Uruguay [in Spanish]. Rev Alerg Mex. 2003;50(3):103–7.PubMedGoogle Scholar
  28. 28.
    Schreck DM, Babin S. Comparison of racemic albuterol and levalbuterol in the treatment of acute asthma in the ED. Am J Emerg Med. 2005;23(7):842–7.Google Scholar
  29. 29.
    Thomas K, Peter JV, Cherian AM, Guyatt G. Cost-effectiveness of inhaled beta-agonists v. oral salbutamol in asthma: a randomized double-blind cross-over study. Natl Med J India. 1996;9(4):159–62.PubMedGoogle Scholar
  30. 30.
    Andersson F, Stahl E, Barnes PJ, Lofdahl CG, O’Byrne PM, Pauwels RA, et al. Adding formoterol to budesonide in moderate asthma–health economic results from the FACET study. Respir Med. 2001;95(6):505–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Barnes NC, Thwaites RM, Price MJ. The cost-effectiveness of inhaled fluticasone propionate and budesonide in the treatment of asthma in adults and children. Respir Med. 1999;93(6):402–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Bisgaard H, Price MJ, Maden C, Olsen NA. Cost-effectiveness of fluticasone propionate administered via metered-dose inhaler plus babyhaler spacer in the treatment of asthma in preschool-aged children. Chest. 2001;120(6):1835–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Bruggenjurgen B, Ezzat N, Kardos P, Buhl R. Economic evaluation of BDP/formoterol fixed vs two single inhalers in asthma treatment. Allergy. 2010;65(9):1108–15.PubMedGoogle Scholar
  34. 34.
    Bruggenjurgen B, Selim D, Kardos P, Richter K, Vogelmeier C, Roll S, et al. Economic assessment of adjustable maintenance treatment with budesonide/formoterol in a single inhaler versus fixed treatment in asthma. Pharmacoeconomics. 2005;23(7):723–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Doull I, Price D, Thomas M, Hawkins N, Stamuli E, Tabberer M, et al. Cost-effectiveness of salmeterol xinafoate/fluticasone propionate combination inhaler in chronic asthma. Curr Med Res Opin. 2007;23(5):1147–59.PubMedCrossRefGoogle Scholar
  36. 36.
    Ericsson K, Bantje TA, Huber RM, Borg S, Bateman ED. Cost-effectiveness analysis of budesonide/formoterol compared with fluticasone in moderate-persistent asthma. Respir Med. 2006;100(4):586–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Everden P, Lloyd A, Hutchinson J, Plumb J. Cost-effectiveness of eformoterol Turbohaler versus salmeterol Accuhaler in children with symptomatic asthma. Respir Med. 2002;96(4):250–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Gerzeli S, Rognoni C, Quaglini S, Cavallo MC, Cremonesi G, Papi A. Cost-effectiveness and cost-utility of beclomethasone/formoterol versus fluticasone propionate/salmeterol in patients with moderate to severe asthma. Clin Drug Investig. 2012;32(4):253–65.PubMedCrossRefGoogle Scholar
  39. 39.
    Goossens LM, Riemersma RA, Postma DS, van der Molen T, Rutten-van Molken MP. An economic evaluation of budesonide/formoterol for maintenance and reliever treatment in asthma in general practice. Adv Ther. 2009;26(9):872–85.PubMedCrossRefGoogle Scholar
  40. 40.
    Ismaila AS, Risebrough N, Li C, Corriveau D, Hawkins N, FitzGerald JM, et al. COST-effectiveness of salmeterol/fluticasone propionate combination (Advair®) in uncontrolled asthma in Canada. Respir Med. 2014;108(9):1292–302.PubMedCrossRefGoogle Scholar
  41. 41.
    Johansson G, Andreasson EB, Larsson PE, Vogelmeier CF. Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma. Pharmacoeconomics. 2006;24(7):695–708.PubMedCrossRefGoogle Scholar
  42. 42.
    Lundback B, Jenkins C, Price MJ, Thwaites RM. Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 microg twice daily and budesonide 800 microg twice daily in the treatment of adults and adolescents with asthma. International Study Group. Respir Med. 2000;94(7):724–32.PubMedCrossRefGoogle Scholar
  43. 43.
    Lundborg M, Wille S, Bjermer L, Tilling B, Lundgren M, Telg G, et al. Maintenance plus reliever budesonide/formoterol compared with a higher maintenance dose of budesonide/formoterol plus formoterol as reliever in asthma: an efficacy and cost-effectiveness study. Curr Med Res Opin. 2006;22(5):809–21.PubMedCrossRefGoogle Scholar
  44. 44.
    Malone DC, Luskin AT. Hydrofluoroalkane-134a beclomethasone as a dominant economic asthma therapy. Respir Med. 2003;97(12):1269–76.PubMedCrossRefGoogle Scholar
  45. 45.
    Miller E, FitzGerald JM. Budesonide/formoterol as maintenance and reliever treatment compared to fixed dose combination strategies—a Canadian economic evaluation. Can J Clin Pharmacol. 2008;15(2):e165–76.PubMedGoogle Scholar
  46. 46.
    Miller E, Sears MR, McIvor A, Liovas A. Canadian economic evaluation of budesonide-formoterol as maintenance and reliever treatment in patients with moderate to severe asthma. Can Respir J. 2007;14(5):269–75.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Miyagawa T, Arakawa I, Shiragami M, Nishimura S. Cost-effectiveness of including salmeterol in asthma therapy in a primary care setting in Japan. Yakugaku Zasshi. 2006;126(1):51–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Paggiaro P, Patel S, Nicolini G, Pradelli L, Zaniolo O, Papi A. Stepping down from high dose fluticasone/salmeterol to extrafine BDP/F in asthma is cost-effective. Respir Med. 2013;107(10):1531–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Price D, Haughney J, Duerden M, Nicholls C, Moseley C. The cost effectiveness of chlorofluorocarbon-free beclomethasone dipropionate in the treatment of chronic asthma: a cost model based on a 1-year pragmatic, randomised clinical study. Pharmacoeconomics. 2002;20(10):653–64.PubMedCrossRefGoogle Scholar
  50. 50.
    Price D, Haughney J, Lloyd A, Hutchinson J, Plumb J. An economic evaluation of adjustable and fixed dosing with budesonide/formoterol via a single inhaler in asthma patients: the ASSURE study. Curr Med Res Opin. 2004;20(10):1671–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Price D, Wiren A, Kuna P. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy. Allergy. 2007;62(10):1189–98.PubMedCrossRefGoogle Scholar
  52. 52.
    Price DB, Cargill K, Wolfe S, Darby H. Salmeterol xinafoate: an analysis of outcomes and cost-effectiveness using a primary care database. Respir Med. 1998;92(11):1302–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Rodriguez-Martinez CE, Sossa-Briceno MP, Castro-Rodriguez JA. Cost-utility analysis of the inhaled steroids available in a developing country for the management of pediatric patients with persistent asthma. J Asthma. 2013;50(4):410–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Rutten-van Molken MP, van Doorslaer EK, Till MD. Cost-effectiveness analysis of formoterol versus salmeterol in patients with asthma. Pharmacoeconomics. 1998;14(6):671–84.PubMedCrossRefGoogle Scholar
  55. 55.
    Stallberg B, Ekstrom T, Neij F, Olsson P, Skoogh BE, Wennergren G, et al. A real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma. Respir Med. 2008;102(10):1360–70.PubMedCrossRefGoogle Scholar
  56. 56.
    Stempel DA, Stanford RH, Thwaites R, Price MJ. Cost-efficacy comparison of inhaled fluticasone propionate and budesonide in the treatment of asthma. Clin Ther. 2000;22(12):1562–74.PubMedCrossRefGoogle Scholar
  57. 57.
    Volmer T, Kielhorn A, Weber HH, Wiessmann KJ. Cost effectiveness of fluticasone propionate and flunisolide in the treatment of corticosteroid-naive patients with moderate asthma. Pharmacoeconomics. 1999;16(5 Pt 2):525–31.PubMedCrossRefGoogle Scholar
  58. 58.
    Weiss K, Buxton M, Andersson FL, Lamm CJ, Liljas B, Sullivan SD. Cost-effectiveness of early intervention with once-daily budesonide in children with mild persistent asthma: results from the START study. Pediatr Allergy Immunol. 2006;17(Suppl 17):21–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Wickstrom J, Dam N, Malmberg I, Hansen BB, Lange P. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark: cost-effectiveness analysis based on five randomised controlled trials. Clin Respir J. 2009;3(3):169–80.PubMedCrossRefGoogle Scholar
  60. 60.
    Paltiel AD, Fuhlbrigge AL, Kitch BT, Liljas B, Weiss ST, Neumann PJ, et al. Cost-effectiveness of inhaled corticosteroids in adults with mild-to-moderate asthma: results from the asthma policy model. J Allergy Clin Immunol. 2001;108(1):39–46.PubMedCrossRefGoogle Scholar
  61. 61.
    Perera BJ. Efficacy and cost effectiveness of inhaled steroids in asthma in a developing country: an epilogue. Arch Dis Child. 1995;73(5):482.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Sullivan SD, Buxton M, Andersson LF, Lamm CJ, Liljas B, Chen YZ, et al. Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma. J Allergy Clin Immunol. 2003;112(6):1229–36.PubMedCrossRefGoogle Scholar
  63. 63.
    Palmqvist M, Price MJ, Sondhi S. Cost-effectiveness analysis of salmeterol/fluticasone propionate 50/250 μg vs fluticasone propionate 250 μg in adults and adolescents with asthma IV: results. Pharmacoeconomics. 1999;16(Suppl 2):23.CrossRefGoogle Scholar
  64. 64.
    Johansson G, Price MJ, Sondhi S. Cost-effectiveness analysis of salmeterol/fluticasone propionate 50/100 μg vs fluticasone propionate 100 μg in adults and adolescents with asthma III: results. Pharmacoeconomics. 1999;16(Suppl 2):15.CrossRefGoogle Scholar
  65. 65.
    Price D, Small I, Haughney J, Ryan D, Gruffydd-Jones K, Lavorini F, et al. Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol: a retrospective matched observational study of real-world patients. Prim Care Respir J. 2013;22(4):439–48.PubMedCrossRefGoogle Scholar
  66. 66.
    Stanciole AE, Ortegon M, Chisholm D, Lauer JA. Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e608.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Willson J, Bateman ED, Pavord I, Lloyd A, Krivasi T, Esser D. Cost effectiveness of tiotropium in patients with asthma poorly controlled on inhaled glucocorticosteroids and long-acting beta-agonists. Appl Health Econ Health Policy. 2014;12(4):447–59.PubMedCrossRefGoogle Scholar
  68. 68.
    Andersson F, Kjellman M, Forsberg G, Moller C, Arheden L. Comparison of the cost-effectiveness of budesonide and sodium cromoglycate in the management of childhood asthma in everyday clinical practice. Ann Allergy Asthma Immunol. 2001;86(5):537–44.PubMedCrossRefGoogle Scholar
  69. 69.
    Borker R, Emmett A, Jhingran P, Rickard K, Dorinsky P. Determining economic feasibility of fluticasone propionate-salmeterol vs montelukast in the treatment of persistent asthma using a net benefit approach and cost-effectiveness acceptability curves. Ann Allergy Asthma Immunol. 2005;95(2):181–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Heaton PC, Guo JJ, Hornung RW, Johnston JA, Jang R, Moomaw CJ, et al. Analysis of the effectiveness and cost benefit of leukotriene modifiers in adults with asthma in the Ohio Medicaid population. J Manag Care Pharm. 2006;12(1):33–42.PubMedGoogle Scholar
  71. 71.
    Menendez R, Stanford RH, Edwards L, Kalberg C, Rickard K. Cost-efficacy analysis of fluticasone propionate versus zafirlukast in patients with persistent asthma. Pharmacoeconomics. 2001;19(8):865–74.PubMedCrossRefGoogle Scholar
  72. 72.
    O’Connor RD, Nelson H, Borker R, Emmett A, Jhingran P, Rickard K, et al. Cost effectiveness of fluticasone propionate plus salmeterol versus fluticasone propionate plus montelukast in the treatment of persistent asthma. Pharmacoeconomics. 2004;22(12):815–25.PubMedCrossRefGoogle Scholar
  73. 73.
    O’Connor RD, O’Donnell JC, Pinto LA, Wiener DJ, Legorreta AP. Two-year retrospective economic evaluation of three dual-controller therapies used in the treatment of asthma. Chest. 2002;121(4):1028–35.PubMedCrossRefGoogle Scholar
  74. 74.
    Price D, Musgrave S, Wilson E, Sims E, Shepstone L, Blyth A, et al. A pragmatic single-blind randomised controlled trial and economic evaluation of the use of leukotriene receptor antagonists in primary care at steps 2 and 3 of the national asthma guidelines (ELEVATE study). Health Technol Assess. 2011;15(21):1–132.PubMedCrossRefGoogle Scholar
  75. 75.
    Rely K, McQuire SE, Alexandre PK, Escudero GS. Cost effectiveness of treatment with salmeterol/fluticasone compared to montelukast for the control of persistent asthma in children [in Spanish]. Value Health. 2011;14(5 Suppl 1):S43–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Sheth K, Borker R, Emmett A, Rickard K, Dorinsky P. Cost-effectiveness comparison of salmeterol/fluticasone propionate versus montelukast in the treatment of adults with persistent asthma. Pharmacoeconomics. 2002;20(13):909–18.PubMedCrossRefGoogle Scholar
  77. 77.
    Shih YC, Mauskopf J, Borker R. A cost-effectiveness analysis of first-line controller therapies for persistent asthma. Pharmacoeconomics. 2007;25(7):577–90.PubMedCrossRefGoogle Scholar
  78. 78.
    Stempel DA, Kruzikas DT, Manjunath R. Comparative efficacy and cost of asthma care in children with asthma treated with fluticasone propionate and montelukast. J Pediatr. 2007;150(2):162–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Tan H, Sarawate C, Singer J, Elward K, Cohen RI, Smart BA, et al. Impact of asthma controller medications on clinical, economic, and patient-reported outcomes. Mayo Clin Proc. 2009;84(8):675–84.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Wang L, Hollenbeak CS, Mauger DT, Zeiger RS, Paul IM, Sorkness CA, et al. Cost-effectiveness analysis of fluticasone versus montelukast in children with mild-to-moderate persistent asthma in the Pediatric Asthma Controller Trial. J Allergy Clin Immunol. 2011;127(1):161–6, 6.e1.Google Scholar
  81. 81.
    Wilson EC, Price D, Musgrave SD, Sims EJ, Shepstone L, Murdoch J, et al. Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic trial. Pharmacoeconomics. 2010;28(7):597–608.PubMedCrossRefGoogle Scholar
  82. 82.
    Wilson EC, Sims EJ, Musgrave SD, Shepstone L, Blyth A, Murdoch J, et al. Cost effectiveness of leukotriene receptor antagonists versus inhaled corticosteroids for initial asthma controller therapy: a pragmatic trial. Pharmacoeconomics. 2010;28(7):585–95.PubMedCrossRefGoogle Scholar
  83. 83.
    Brown R, Turk F, Dale P, Bousquet J. Cost-effectiveness of omalizumab in patients with severe persistent allergic asthma. Allergy. 2007;62(2):149–53.PubMedCrossRefGoogle Scholar
  84. 84.
    Campbell JD, Spackman DE, Sullivan SD. The costs and consequences of omalizumab in uncontrolled asthma from a USA payer perspective. Allergy. 2010;65(9):1141–8.PubMedGoogle Scholar
  85. 85.
    Dal Negro RW, Tognella S, Pradelli L. A 36-month study on the cost/utility of add-on omalizumab in persistent difficult-to-treat atopic asthma in Italy. J Asthma. 2012;49(8):843–8.CrossRefGoogle Scholar
  86. 86.
    Faria R, McKenna C, Palmer S. Optimizing the position and use of omalizumab for severe persistent allergic asthma using cost-effectiveness analysis. Value Health. 2014;17(8):772–82.PubMedCrossRefGoogle Scholar
  87. 87.
    Levy AN, Garcia ARAJ, Garcia-Agua Soler N, Sanjuan MV. Cost-effectiveness of omalizumab in severe persistent asthma in Spain: a real-life perspective. J Asthma. 2015;52(2):205–10.PubMedCrossRefGoogle Scholar
  88. 88.
    Norman G, Faria R, Paton F, Llewellyn A, Fox D, Palmer S, et al. Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation. Health Technol Assess. 2013;17(52):1–342.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Oba Y, Salzman GA. Cost-effectiveness analysis of omalizumab in adults and adolescents with moderate-to-severe allergic asthma. J Allergy Clin Immunol. 2004;114(2):265–9.PubMedCrossRefGoogle Scholar
  90. 90.
    van Nooten F, Stern S, Braunstahl GJ, Thompson C, Groot M, Brown RE. Cost-effectiveness of omalizumab for uncontrolled allergic asthma in the Netherlands. J Med Econ. 2013;16(3):342–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Vennera Mdel C, Valero A, Uria E, Forne C, Picado C. Cost-effectiveness analysis of omalizumab for the treatment of severe persistent asthma in real clinical practice in Spain. Clin Drug Investig. 2016;36(7):567–78.PubMedCrossRefGoogle Scholar
  92. 92.
    Wu AC, Paltiel AD, Kuntz KM, Weiss ST, Fuhlbrigge AL. Cost-effectiveness of omalizumab in adults with severe asthma: results from the Asthma Policy Model. J Allergy Clin Immunol. 2007;120(5):1146–52.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Yoshikawa H, Iwata M, Matsuzaki H, Ono R, Murakami Y, Taba N, et al. Impact of omalizumab on medical cost of childhood asthma in Japan. Pediatr Int. 2016;58(5):425–8.PubMedCrossRefGoogle Scholar
  94. 94.
    Morishima T, Ikai H, Imanaka Y. Cost-effectiveness analysis of omalizumab for the treatment of severe asthma in japan and the value of responder prediction methods based on a multinational trial. Value Health Reg Issues. 2013;2(1):29–36.PubMedCrossRefGoogle Scholar
  95. 95.
    Dal Negro RW, Pradelli L, Tognella S, Micheletto C, Iannazzo S. Cost-utility of add-on omalizumab in difficult-to-treat allergic asthma in Italy. Eur Ann Allergy Clin Immunol. 2011;43(2):45–53.Google Scholar
  96. 96.
    Dewilde S, Turk F, Tambour M, Sandstrom T. The economic value of anti-IgE in severe persistent, IgE-mediated (allergic) asthma patients: adaptation of INNOVATE to Sweden. Curr Med Res Opin. 2006;22(9):1765–76.PubMedCrossRefGoogle Scholar
  97. 97.
    Zafari Z, Sadatsafavi M, Marra CA, Chen W, FitzGerald JM. Cost-effectiveness of bronchial thermoplasty, omalizumab, and standard therapy for moderate-to-severe allergic asthma. PLoS One. 2016;11(1):e0146003.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Perera BJ. Efficacy and cost effectiveness of inhaled steroids in asthma in a developing country. Archives of disease in childhood. 1995;72(4):312–5 (discussion 5–6).Google Scholar
  99. 99.
    Price DB, Appleby JL. Fluticasone propionate: an audit of outcomes and cost-effectiveness in primary care. Respir Med. 1998;92(2):351–3.PubMedCrossRefGoogle Scholar
  100. 100.
    Stempel DA. Economic analysis of asthma practices. American journal of managed care. 2000;6(17 Suppl):S930–6; (discussion S7–9).Google Scholar
  101. 101.
    Price MJ, Briggs AH. Development of an economic model to assess the cost effectiveness of asthma management strategies. Pharmacoeconomics. 2002;20(3):183–94.PubMedCrossRefGoogle Scholar
  102. 102.
    Scottish Intercollegiate Guidelines Network (SIGN). British guideline on the management of asthma: a national clinical guideline. Edinburgh: SIGN; 2016.Google Scholar
  103. 103.
    Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2017. Accessed 9 Jan 2018
  104. 104.
    Tadrous M, Khuu W, Lebovic G, Stanbrook MB, Martins D, Paterson JM, et al. Real-world health care utilization and effectiveness of omalizumab for the treatment of severe asthma. Ann Allergy Asthma Immunol. 2018;120(1):59–65.e2.Google Scholar
  105. 105.
    Beca J, Chan KK. Cost-effectiveness of pazopanib: an example of improved transparency and accessibility of industry-sponsored economic evaluations through publication in peer-reviewed journals. Curr Oncol. 2016;23(4):e327–9.PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103.PubMedCrossRefGoogle Scholar
  107. 107.
    Ten Jonsson B. arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ. 2009;10(4):357–9.CrossRefGoogle Scholar
  108. 108.
    Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000;17(5):479–500.PubMedCrossRefGoogle Scholar
  109. 109.
    Kim DD, Wilkinson CL, Pope EF, Chambers JD, Cohen JT, Neumann PJ. The influence of time horizon on results of cost-effectiveness analyses. Exp Rev Pharmacoecon Outcomes Res. 2017;17(6):615–23.CrossRefGoogle Scholar
  110. 110.
    Wisniewski JA, McLaughlin AP, Stenger PJ, Patrie J, Brown MA, El-Dahr JM, et al. A comparison of seasonal trends in asthma exacerbations among children from geographic regions with different climates. Allergy Asthma Proc. 2016;37(6):475–81.PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Weinstein MC, O’Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health. 2003;6(1):9–17.PubMedCrossRefGoogle Scholar
  112. 112.
    Cohen DJ, Reynolds MR. Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol. 2008;52(25):2119–26.PubMedPubMedCentralCrossRefGoogle Scholar
  113. 113.
    Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, et al. Asthma outcomes: healthcare utilization and costs. J Allergy Clin Immunol. 2012;129(3 Suppl):S49–64.PubMedPubMedCentralCrossRefGoogle Scholar
  114. 114.
    Dilokthornsakul P, Chaiyakunapruk N, Campbell JD. Does the use of efficacy or effectiveness evidence in cost-effectiveness analysis matter? J Asthma. 2017;54(1):17–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatrics, School of MedicineUniversidad Nacional de ColombiaBogotaColombia
  2. 2.Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of MedicineUniversidad El BosqueBogotaColombia
  3. 3.Department of Internal Medicine, School of MedicineUniversidad Nacional de ColombiaBogotaColombia
  4. 4.Division of Pediatrics, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

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