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BACKGROUND: An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (triple therapy) to treatment with high doses of inhaled corticosteroids-long-acting beta2-agonist (dual therapy). The purpose of this study was to assess the cost-effectiveness of triple therapy versus dual therapy for patients with severe asthma. METHODS: A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of dual and triple therapy were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. RESULTS: The model suggests a potential gain of 1.55 QALYs per patient per year on triple therapy with respect to dual therapy. We observed a difference of US$304 in discounted cost per person-year on triple therapy with respect to dual therapy. The incremental cost-effectiveness ratio was US$196 in the probabilistic model. In the sensitivity analysis, our base-case results were robust to variations in all assumptions and parameters. CONCLUSION: In conclusion, triple therapy in patients with moderate-severe asthma was cost-effective. Using triple therapy emerges with our results as an alternative before using oral corticosteroids or biologics, especially in resource-limited settings.

Original publication




Journal article


BMC Pulm Med

Publication Date





Cost-effectiveness analysis, Decision analysis, Markov model, Tiotropium, Uncontrolled asthma, Adolescent, Adrenal Cortex Hormones, Adrenergic beta-2 Receptor Agonists, Adult, Asthma, Cholinergic Agents, Colombia, Cost-Benefit Analysis, Drug Therapy, Combination, Female, Humans, Male, Markov Chains, Nebulizers and Vaporizers, Quality-Adjusted Life Years, Young Adult