Cost-effectiveness of budesonide-formoterol vs inhaled epinephrine in US adults with mild asthma

Background: The management of mild asthma has lacked an over-the-counter (OTC) option aside from inhaled epinephrine, which is available in the United States. However, inhaled epinephrine use without an inhaled corticosteroid may increase the risk of asthma death. Objective: To compare the cost-effectiveness of OTC as -needed budesonide-formoterol as a plausible alternative to inhaled epinephrine. Methods: We developed a probabilistic Markov model to compare OTC as -needed budesonide-formoterol inhaler use vs inhaled epinephrine use in adults with mild asthma from a US societal perspective over a lifetime horizon, with a 3% annual discount rate (2022 US dollars). Inputs were derived from the SYmbicort Given asneeded in Mild Asthma (SYGMA) trials, published literature, and commercial costs. Outcomes were qualityadjusted life -years (QALY), costs, incremental net monetary benefit (INMB), severe asthma exacerbations, wellcontrolled asthma days, and asthma -related deaths. Microsimulation was used to evaluate underinsured Americans living with mild asthma (n = 5,250,000). Results: Inhaled epinephrine was dominated (with lower QALYs gains at a higher cost) by both as -needed budesonide-formoterol (INMB, $15,541 at a willingness -to -pay of $100,000 per QALY) and the no -OTC inhaler option (INMB, $1023). Adults using as -needed budesonide-formoterol had 145 more well -controlled asthma days, 2.79 fewer severe exacerbations, and an absolute risk reduction of 0.23% for asthma -related death compared with inhaled epinephrine over a patient lifetime. As -needed budesonide-formoterol remained dominant in all sensitivity and scenario analyses, with a 100% probability of being cost-effective compared with inhaled epinephrine in probabilistic sensitivity analysis. Conclusion: If made available, OTC as -needed budesonide-formoterol for treating mild asthma in underinsured adults without HCP management improves asthma outcomes, prevents fatalities, and is cost -saving. (c) 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.