Unveiling the Best Asthma Control Regiment: A Comprehensive Meta-Analysis and Meta-Regression of Efficacy, Safety, and Cost-Effectiveness

BackgroundAsthma remains a major global health concern, requiring effective and cost-efficient treatment strategies. Long-acting beta-agonists (LABAs), particularly in combination with inhaled corticosteroids (ICS), are widely used to manage symptoms and prevent exacerbations. However, uncertainty persists regarding the optimal regimen in terms of effectiveness, safety, and affordability, especially in resource-limited settings. This study evaluates the effectiveness, safety, and cost-efficiency of ICS/LABA regimens versus alternative asthma treatments, focusing on exacerbations, lung function, symptom control, and cost-effectiveness, especially in resource-limited settings. MethodologyAn extensive search across databases such as Scopus, PubMed, Cochrane, and others was conducted, focusing on asthma treatments. Our inclusion criteria covered RCTs on asthma, ICS/LABA regimens, comparisons with alternative treatments. Key outcomes included incidence of exacerbation, Forced Expiratory Volume (FEV1), Peak Expiratory Flow Rate (PEFR), Asthma Control Questionnaire (ACQ-5) scores, and cost-effectiveness, covering a broad range of patient demographics. The analysis compared ICS/LABA combinations to alternative therapies, synthesizing outcomes using standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) through random-effect models. Quality assessment followed the Cochrane Collaborations RoB-2 tool, and meta-analyses were performed in R-Studio. The cost analysis was also conducted utilizing tornado plots, which outline what influences costs. ResultsA total of 5,083 studies were identified, with 11 meeting inclusion criteria (19,905 participants). Meta-analysis showed ICS/LABA combinations significantly reduced exacerbations (RR = 0.67, 95% CI: 0.54-0.84) but had minimal impact on FEV1 and ACQ-5 scores. PEFR improved significantly (SMD = 1.25, 95% CI: 1.09-1.40). Meta-regression indicated that age and follow-up duration had minor effects on PEFR but did not influence exacerbations. Cost analysis found ICS/LABA treatments cost up to $150, while terbutaline costs under $50, offering up to 66.7% savings. Further research is needed to balance cost-effectiveness with treatment efficacy in asthma management. ConclusionThis study confirms that ICS/LABA combinations reduce exacerbations and improve PEFR, though with minimal effects on FEV1 and ACQ-5 scores. Meta-regression showed slight PEFR variations by age and follow-up. Cost analysis suggests up to 66.7% savings with terbutaline, though ICS/LABA offers superior outcomes. Balancing efficacy and cost is crucial for optimizing asthma management.