Cost-Effectiveness Analysis of Inhaled Corticosteroids for Mild and Moderate Asthma in Thai Health Care Context

Abstract

Asthma is a common chronic disease with an estimated prevalence of 10-13% of children and 5-9% of adult population in Thailand. Asthma places an economic burden to health care system due to high rates of emergency visits and hospitalization. Currently, the Thai Thoracic Physician Association recommends the use of inhaled corticosteroids (ICS) according to GINA guideline for patients with persistent asthma of all stages. However, ICS has been underutilized in most medical practice because of its relatively expensive cost. This study aims to determine an incremental cost-effectiveness ratio (ICER) of ICS used with short acting beta-2 agonists, compared with the beta-2 agonists alone in patients with mild and moderate asthma, aged 18-35 and over 35 years who had or had no prior hospitalization, using health care provider perspective Effectiveness and quality of life data were obtained from Asthma Policy Model used in the us. Cost data were abstracted from electronic databases in 18 provincial hospitals. Markov Model with one-month cycle was used for data analysis. Over a 10-year period, ICER of ICS for a group of patients with mild asthma, no prior hospitalization, and age 18-35 years was Baht -2,636 per quality-adjusted life month (QALM). For a group of moderate asthma with more than one prior hospitalization and age over 35 years, ICER decreased to Baht -15,602 per QALM. For the 5-year time frame, ICER per QALM for the two groups increased to Baht 1,340 and -9,423, respectively. For 3 years of drug use, ICER increased to Baht 3,255 and -4,743, respectively. In conclusion, ICS is considered the cost-effective treatment for asthma in Thai health care context.