Is albuterol (Salbutamol)/budesonide a good cost-effective rescue inhaler?

From the Guidelines

Albuterol/budesonide (Airsupra) is not typically considered a cost-effective rescue inhaler option. For cost-effective rescue inhalers, standard albuterol (ProAir, Ventolin, or generic versions) remains the most economical choice, typically costing $30-60 per inhaler with insurance coverage. Albuterol/budesonide combines a rescue bronchodilator (albuterol) with an anti-inflammatory steroid (budesonide) and is significantly more expensive, often costing $150-400 per inhaler even with insurance. This combination was approved in 2023 and may offer benefits for patients with uncontrolled asthma by providing immediate symptom relief while simultaneously addressing underlying inflammation, potentially reducing the risk of severe exacerbations. However, for most patients requiring only occasional rescue medication, standard albuterol provides adequate symptom relief at a much lower cost. Patients should discuss with their healthcare provider whether the additional benefits of the combination justify the substantially higher price based on their specific asthma control needs and financial situation.

Some key points to consider:

• The cost of albuterol/budesonide is significantly higher than standard albuterol 1
• Standard albuterol is effective for occasional rescue medication and is a more economical choice 1
• Albuterol/budesonide may offer benefits for patients with uncontrolled asthma, but the additional cost must be weighed against the potential benefits 1
• Patients should discuss their specific needs and financial situation with their healthcare provider to determine the best option for them.

In terms of medication options, the following are available:

• Standard albuterol (ProAir, Ventolin, or generic versions)
• Albuterol/budesonide (Airsupra)
• Other rescue inhalers, such as levalbuterol or pirbuterol, may also be considered, but are not typically as cost-effective as standard albuterol.

It's worth noting that the most recent and highest quality study on this topic is not explicitly stated in the provided evidence, but based on the available information, standard albuterol remains the most cost-effective option for rescue inhalation.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Albuterol/Budesonide as a Cost-Effective Rescue Inhaler

• The combination of albuterol and budesonide as a rescue inhaler has been shown to reduce the risk of severe asthma exacerbations compared to albuterol alone 2, 3.
• A study published in the New England Journal of Medicine found that the use of a fixed-dose combination of albuterol and budesonide as rescue medication reduced the risk of severe asthma exacerbation by 26% compared to albuterol alone 2.
• Another study published in the Annals of Internal Medicine also found that as-needed albuterol-budesonide reduced severe exacerbations compared to albuterol alone 3.

Efficacy and Safety

• The MANDALA study, a randomized, double-blind, active-controlled trial, found that albuterol/budesonide was effective and safe in reducing severe asthma exacerbations in adults and children aged ≥4 years with moderate-to-severe asthma 4.
• The study found that the incidence of adverse events was similar in the three trial groups, indicating that albuterol/budesonide is a safe and effective option for rescue therapy 2.

Cost-Effectiveness

• While the provided studies do not directly address the cost-effectiveness of albuterol/budesonide as a rescue inhaler, they do suggest that it may be a cost-effective option by reducing the risk of severe asthma exacerbations and the associated healthcare costs 2, 3, 5.
• A study published in The Journal of Allergy and Clinical Immunology: In Practice suggests that the use of albuterol-budesonide as reliever therapy can improve outcomes and reduce exacerbation risk, which may lead to cost savings 5.

Comparison to Other Therapies

• A study published in The Journal of Allergy and Clinical Immunology: In Practice compares the use of budesonide/formoterol or budesonide/albuterol as anti-inflammatory reliever therapy for asthma, and suggests that both options may be effective in reducing exacerbations 6.
• However, the study notes that head-to-head clinical studies are needed to compare the two options and determine which is more effective and cost-effective 6.