Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma exacerbations: a cost-effectiveness analysis

Objective: \nAlthough the efficacy of systemic corticosteroids (SCs) in acute asthma exacerba- tions is well established, the fact that many children still require admission to hospital and that SCs have a slow onset of action are cause of concern. For this reason, the use of inhaled corticosteroids (ICS) as a therapy added to SCs has been explored, with no clarity about its cost-effectiveness. The aim of the present study was to evaluate the cost-effective- ness of ICS in addition to SCs (ICSþSCs) compared to standard therapy with SCs for treat- ing pediatric asthma exacerbations.\n\nMethods:\nA decision-analysis model was developed to estimate the cost-effectiveness of SCs compared to ICSþSCs for treating pediatric patients with acute asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data obtained from hospital bills and from the national manual of drug prices. The study was car- ried out from the perspective of the national healthcare system in Colombia. The main out- come of the model was avoidance of hospital admission.\n\nResults:\nFor the base-case analysis, the model showed that compared to SCs, therapy with ICSþSCs was associated with lower total costs (US$88.76 vs.US$97.71 average cost per patient) and a lower probability of hospital admission (0.9060 vs. 0.9000), thus show- ing dominance.\n\nConclusions:\nThis study shows that compared with standard therapy with SCs, ICSþSCs for treating pediatric patients with acute asthma exacerbations is the preferred strategy because it was associated with a lower probability of hospital admission, at lower total treat- ment costs.