Cost effectiveness of the addition of inhaled corticosteroid in moderately persistent asthmatics treated with daily oral bronchodilator

Inhaled corticosteroid (ICS) is proved to be a very effective medication in controlling asthma. However it is not widely used in Indonesian patients due to high cost of the drug for most patients. On the other hand, there are also somewhat reluctant altitude of physicians in prescribing ICS. The purpose of the study was to evaluate the efficacy of regular daily oral bronchodilator in a group of moderately persistent asthmatics compared to the other group treated with the same regimen with the addition of inhaled steroid (BUD) for six month period of treatment. Cost benefit analysis were made between the two groups. In a prospective randomized, controlled study, forty moderately persistent asthmatic patients visiting Asthma Clinic Dept. of Pulmonology Persahabatan Hospital, Jakarta were devided into two groups. The first group (TS) was treated with regular daily divided dose of oral bronchodilator consisted of combination of theophyllin 130 mg and salbutamol 1 mg, the second group (BUD) received the the same medication with the addition of inhaled budesonide via turbuhaler 400 meg twice daily. The following parameters were measured to assess cost-effectiveness of therapy: clinical symptoms, nocturnal asthma, symptoms free days, work or schoolday loss, lung function parameter (daily peak flow rate, PFR; force expiratory volume 1 second, FEV₁; force vital capacity, FVC), treatment cost, medication cost, clinic visit cost, emergency visit cost, hospital cost, cost of workday lost or school. The results showed that BUD group were far more superior in clinical benefit in terms of reduction of daily symptoms, reduction of nocturnal asthma, reduction school or work loss, improvement of all lung function parameter, and the most important, the total treatment cost was slightly less than TS group. It is concluded that inhaled corticosteroid in combination with daily oral bronchodilator significantly improved the quality of life in moderately persistent asthmatics compared to daily oral bronchodilator alone, the total treatment cost was even slightly less than the latter.