A large U.S.‑based economic analysis suggests that a guideline‑recommended asthma treatment approach known as Single Maintenance and Reliever Therapy (SMART) could significantly reduce national health care spending while improving patient outcomes. The analysis was detailed in the study, “Costs of Single Maintenance and Reliever Therapy vs. Traditional Therapy for Asthma,” recently published in JAMA Network Open.
The study evaluated 11,988 participants and used advanced decision‑tree and Monte Carlo modeling techniques. SMART, which uses a single inhaler containing inhaled corticosteroid–formoterol for both daily control and rescue relief, has been recommended by leading asthma guidelines for years, according to the study’s authors. It’s adoption in the United States, however, remains low due to limited insurance coverage and restrictive pharmacy benefit manager (PBM) formularies. The study authors maintain that this new analysis may provide payers with compelling financial justification to expand access.
Researchers found that patients treated with SMART incurred lower total annual asthma management costs — an average of $2,181 per patient annually, compared with $2,235 for traditional therapy. Although the difference appears modest per person, researchers emphasized that savings scale dramatically at the population level
SMART also provided slightly better health outcomes, the authors noted, delivering a small but measurable gain in quality‑adjusted life‑years (QALYs) and reducing the frequency of severe asthma exacerbations. The approach proved to be a cost savings in 57% of model simulations and cost effective in 67% when QALYs were included.
The study emphasized that although SMART relies on an inhaler that is generally more expensive than the medications used in traditional therapy, its clinical advantage lies in reducing severe asthma attacks — events that frequently result in costly emergency department visits or hospitalizations. The model showed that more than 80% of total asthma care costs stem from inhalers themselves, making price reductions or generic availability a critical factor, they said.
Additionally, researchers noted that SMART’s structure — pairing symptom relief with inhaled corticosteroids — helps offset issues with medication adherence. They said that although many patients struggle to take daily maintenance inhalers as prescribed, SMART ensures they still receive anti‑inflammatory medication with each rescue use, potentially preventing severe flare‑ups.
The study’s findings conclude that SMART offers a practical, evidence‑based solution that could lower costs and improve outcomes for millions. Researchers argue that broader coverage of budesonide–formoterol combination inhalers — particularly allowing patients access to multiple inhalers per month — could close persistent implementation gaps and reduce preventable asthma‑related morbidity.
