Introduction: Low-dose inhaled corticosteroids (ICS) fails to control asthma symptoms in around 10%–15% of children. The EstablishINg the best STEp-up treatments for children with uncontrolled asthma despite INhaled corticosteroids (EINSTEIN) study included an economic evaluation to compare the clinical and cost-effectiveness of different doses of ICS, long-acting β2-adrenoceptor agonists (LABA) and leukotriene receptor antagonists (LTRA).

Aims and objective: To estimate the incremental cost per quality-adjusted life years (QALY) gained using a decision analytic model and by adopting the perspective of the National Health System (NHS) and Personal Social Services (PSS) in the UK.

Methods: We developed a Markov state transition model to simulate resource use and health outcomes to estimate the cost effectiveness of alternative treatment regimens. Literature reviews were performed to identify health state utilities and costs based on patients’ use of primary and secondary care services and PSS. The analysis adopted a 1-year time horizon.

Results: Low-dose ICS was the most cost-effective treatment option with an Incremental Cost Effectiveness Ratio (ICER) of £4,060 per QALY gained versus LTRA. Medium dose ICS had an ICER of £292,280 per QALY gained, while medium dose ICS plus LABA, high dose ICS and medium dose ICS plus LTRA were dominated. These findings were mostly robust to sensitivity analyses.

Conclusion: Although the model indicated that medium-dose ICS generated the highest number of QALYs, low dose ICS was more cost-effective due to the lower price of inhalers.