Budesonide/Formoterol Maintenance and Reliever Therapy in Childhood Asthma: Real-World Effectiveness and Economic Assessment

With wider utilization of budesonide-formoterol as maintenance and reliever therapy (MART), this retrospective cohort study examined the real-world effectiveness and economic benefits of MART in a pediatric cohort in China.Retrospective cohort study in 103 patients younger than 18 years with confirmed diagnosis of asthma started on MART and 63 patients in the control group from January 2020 to December 2021. There were differences between the cohorts, specifically with the MART patients older (9.22 vs 7.01) and male predominant (70.9% versus 57.1%).Data were collected retrospectively from an outpatient data warehouse of Beijing Children’s Hospital who were started on MART, compared with a cohort treated with fixed-dose inhaled corticosteroids only or inhaled corticosteroid-long-acting beta-antagonists as maintenance with short-acting beta-agonist reliever, with assessments at 6 and 12 months. comparing severe exacerbations, defined as failing controller therapy and requiring systemic corticosteroids, emergency department visit or hospitalization, and mild exacerbations defined as onset of acute or subacute symptoms, ie, wheezing, shortness of breath, chest tightness, cough, including at night, and increased use of reliever. A Markov model was used for cost effectiveness since asthma is a chronic disease with episodic acute symptoms.At 6 months, the MART group had a lower risk for mild asthma exacerbations (odds ratio 0.32 confidence interval 0.14–0.75) with no severe asthma exacerbations, whereas the standard therapy patients had 5 severe exacerbations. At 12 months, the MART group had 0 severe exacerbations compared with 7 in the control group. Both groups saw improvement in forced expiratory volume for 1 second, forced vital capacity, and peak expiratory flow, with MART seeing this improvement sooner at 6 months, but both cohorts had equivalent improvement by 12 months. For cost-effectiveness, there was no difference in the cost of medications for the groups. The total costs of outpatient and healthcare services in the MART group was 10 905.44 Chinese Yuan compared with the control group of 21 421.55 Chinese Yuan. Quality-adjusted Life Year for the MART group was 0.87 compared with 0.75 in the control.Utilization of MART in pediatric patients is a highly clinically and economically effective option for the management of asthma, even in 12 months with MART dominating conventional therapy in incremental cost-effectiveness ratio (ICER).This study shows that MART management in pediatric patients can facilitate better asthma control and reduction in health cost burdens in a small patient cohort in China. This study did coincide with the coronavirus disease 2019 pandemic lockdowns, and the smaller size with 2 groups that are not ideally matched does limit generalizability, but the degree of control for severe exacerbations and the total healthcare cost reduction should encourage pediatricians to use MART for their pediatric asthma patients.