, Volume 4, Issue 4, pp 257–270 | Cite as

Cost Effectiveness of Inhaled Corticosteroid plus Bronchodilator Therapy versus Bronchodilator Monotherapy in Children with Asthma

  • M. P. M. H. Rutten-van Mölken
  • E. K. A. Van Doorslaer
  • M. C. C. Jansen
  • E. E. Van Essen-Zandvliet
  • F. F. H. Rutten
Original Research Article


In an incremental cost-effectiveness analysis. combined inhaled β2-receptor agonist plus inhaled coricosteroid therapy (BA + CS) was compared with inhaled β2-agonist plus placebo (BA + PL) in 116 asthmatic children aged 7 to 16 years. Clinical data have been reported previously. To account for the selective withdrawal rate due to pulmonary problems that occurred in the group receiving BA + PL costs were calculated using 2 approaches: (1) the cumulative cost approach and (2) the patient-year approach.

Besides improvements in forced expiratory volume in 1 second (FEV1) and airway responsiveness expressed as the provocative dose of histamine required to give a 20% fall in FEV1 (PD20). the frequency of asthma symptoms and school absenteeism were significantly reduced in the BA + CS group. Annual drug acquisition costs for the group receiving BA + CS were NLG480 higher than for the BA + PL group ($US1 = NLG2.12, 1989 prices). Based on conservative calculations using the cumulative cost approach, annual savings due to reduced healthcare utilisation. excluding the cost of study drugs, by the group receiving BA + CS compared with BA + PL were estimated to be about NLG273 per patient. The incremental cost effectiveness of BA + CS was estimated to be about NLG17S per 10% increase in FEV1, or somewhat less than NLG10 per symptom-free day gained. The patient-year approach estimated savings due to conicosteroids of about 43% of the costs of BA + PL (95% confidence intervals, 21 to 58%). Savings were larger when the indirect costs that a family incurred during school absenteeism were considered.

Addition of an inhaled corticosteroid 10 an inhaled β2-receptor agonist is a cost-effective treatment option that could even result in net healthcare savings.


Asthma Budesonide Asthmatic Child Cromoglycate Sodium Cromoglycate 
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Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • M. P. M. H. Rutten-van Mölken
    • 1
  • E. K. A. Van Doorslaer
    • 2
  • M. C. C. Jansen
    • 1
  • E. E. Van Essen-Zandvliet
    • 3
  • F. F. H. Rutten
    • 2
  1. 1.Department of Health EconomicsUniversity of LimburgMaastrichtThe Netherlands
  2. 2.Institute for Medical Technology Assessment, Erasmus University RotterdamRotterdamThe Netherlands
  3. 3.Department of Paediatries, Subdivision Paediatric Respiratory MedicineUniversity Hospital, Rotterdam/Sophia Children’s HospitalRotterdamThe Netherlands

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