Cited 1 times since 2025 (4.7 per year) source: EuropePMC Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, Volume 36, Issue 6, 1 1 2025, Pages e70113 ADRB2 genotype-guided treatment for childhood asthma: Cost analysis of the PUFFIN and PACT trials. Slob EMA, Frederix GWJ, Vijverberg SJH, Noij LCE, Ruffles T, Vasbinder EC, Mukhopadhyay S, van Schaik RHN, Kersten ETG, Pijnenburg MW, Koppelman GH, Maitland-van der Zee AH, PUFFIN and PACT investigators
Background
Long-acting β2-agonists (LABA) are commonly used to treat asthma. Some children do not respond well to LABA, which may be due to +46G>A-/rs1042713 (Arg16 amino acid) in the ADRB2 gene encoding the β2 receptor. Arg16Gly ADRB2 genotyping to guide treatment step-up decisions in children with uncontrolled asthma despite inhaled corticosteroids (ICS) has been shown to reduce asthma exacerbations. We investigated whether ADRB2 genotype-guided treatment is cost-saving.
Methods
Total semi-annual healthcare and indirect costs for children with and without exacerbations were calculated using PUFFIN trial data. One hundred and two Dutch and Swiss children were randomised to a genotype-guided treatment arm (adding LABA [Gly16Gly] or double dose ICS [Arg16Arg/Arg16Gly]) or a control arm, where children were again randomised to LABA or double dose ICS. We used exacerbation rates of the PUFFIN and the PACT trials to calculate asthma-related healthcare costs per treatment arm, as PACT closely matches the PUFFIN design. The PACT trial randomised 91 children from England and Scotland with uncontrolled asthma to the genotype-guided treatment arm (LABA [Gly16Gly] or montelukast [Arg16Arg/Arg16Gly]) or the control arm (routine care as per British Thoracic Society guidelines).
Results
Overall mean semi-annual costs per child were €56.24 lower in the genotype-guided treatment arm compared to the control arm (€771.07 [range €616.86-€925.28, 23 of 90 children experienced exacerbations] and €827.31 [range €661.85-€992.77, 40 of 103 experienced exacerbations], respectively).
Conclusion
A treatment strategy that includes ADRB2 genotype-guided treatment is potentially cost-saving compared to usual care. The decreased healthcare costs associated with a reduction in asthma exacerbations more than offset the incurred genotyping costs.
