Cost-Utility of Triple Versus Dual Inhaler Therapy in Moderate to Severe Asthma

Jefferson Antonio Buendía; Diana Guerrero Patiño


BMC Pulm Med. 2021;21(398) 

In This Article


Asthma is the most prevalent respiratory disease in all age groups.[1] At least 24% of patients with asthma are classified as severe asthma requiring high doses of inhaled corticosteroids (ICS)-long-acting beta2-agonist (LABA) or ICS-LABA or oral corticosteroids (OCS).[2] The direct cost of severe asthma per patient is three times higher than the cost of mild asthma; a cost that would be higher if we include indirect costs.[3] It is estimated that adults had 1.5 missed days per month due to asthma symptoms and 4.9 days per month of reduced productivity.[4] In this sense, severe asthma is a serious problem for health systems. In US Yaghoubi and colleagues projected the economic and humanistic burden of asthma among U.S. adults from 2019 to 2038; they estimated that there will be around 175 million person-years with uncontrolled asthma and if all those people with uncontrolled asthma in the United States can achieve and maintain asthma control, the saving would be about $300 billion in direct costs and $660 billion in indirect costs, recovering 15,462 quality-adjusted life-years.[5]

Gina 2021 recommends medium or high-dose ICS and LABAs combination ( dual therapy) as a preferred controller.[6] Indeed, despite these drugs, almost 70% of these patients do not achieve total control of symptoms.[2] Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (LAMA) to treatment with ICS-LABA in severe asthma because this triple therapy (ICS + LABA + LAMA) because improves lung function, quality of life and increased the time to severe exacerbation requiring OCS.[6–9] This is a relevant alternative, insofar as it can prevent the patient from ending up using oral corticosteroids or high-cost biologic drugs. However, this recommendation raises concerns as if the extra benefit offered by this drug outweighs the additional cost compared to therapy with only dual therapy. This question is even more relevant in developing countries with an increasing prevalence of asthma and constrained healthcare. An economic evaluation of these new drugs could provide evidence to optimize the efficiency of using economic resources in these countries. This study aimed to use to assess the health and economic consequences of dual inhaled therapy (LABA + ICS) versus triple inhaled therapy (LAMA + LABA + ICS) for the treatment of severe asthma in Colombia.