SMART Treatment for Asthma Reduces Cost and Improves Outcomes

Single maintenance and reliever therapy (SMART) for the treatment of asthma is less expensive for health care plans than traditional asthma therapies, according to a study published in JAMA Network Open.¹

“Although SMART is evidence-based and guideline-recommended, global use remains limited, representing a major implementation gap in asthma management,” wrote authors of the study. “In the US, many pharmacy benefit managers (PBMs) do not place ICS-formoterol pressurized metered-dose inhalers (pMDIs)—the only SMART-compatible inhalers—on their preferred drug lists, thereby restricting patient access.”

With asthma being the most prominent respiratory disease across the globe, researchers and providers alike are constantly looking for new ways to treat patients while keeping the burden of health care costs at a minimum.

One of the most recent guideline changes for asthma treatment came just 5 years ago, when the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) began recommending pressurized metered-dose inhalers. Recommended as both daily-maintenance and rescue therapies, the guidelines were essentially changed due to evidence of risk reductions of severe asthma exacerbations, aligning with the SMART approach.¹

READ MORE: Chronic Corticosteroid Use Harms Health, Increases Cost for Patients With Asthma

Previous Evidence Regarding SMART Inhalers for Asthma

In a committee review of SMART inhalers for asthma published by the National Institute for Health and Care Excellence, there was a slew of risks and benefits uncovered, as well as notable economic and practical barriers. Although one of the key benefits committee members found was increased adherence, SMART inhalers led to 41 more hospital admissions per 1000 people when compared with usual asthma care.²

Furthermore, the committee discovered significant costs per SMART inhaler device with a short life span in their use, meaning that patients would have to afford high costs on a more frequent basis than traditional asthma therapies.

“SMART has been shown to reduce emergency room visits and hospitalizations while improving asthma control and quality of life,” wrote the American Lung Association.³ “With only one inhaler, it’s easier for patients to keep track of their medicines and use them as directed by their doctor.”

With guidelines supporting it but the costs being a downfall, researchers of the current study wanted to explore the cost differences between SMART and traditional therapy in the context of US payers.

“We conducted the first (to our knowledge) US-based cost analysis comparing the estimated annual cost of asthma care for patients prescribed SMART vs traditional therapy from a health care payer perspective,” continued athe authorsof the current study.¹ “We hypothesized that, despite higher medication costs, SMART would be less costly due to reduced downstream asthma-related morbidity.”

Annual Asthma Costs for SMART and Traditional Treatment Options

To increase their knowledge of SMART and its use among patients with asthma, researchers conducted an economic evaluation comparing the total asthma management cost of either SMART or traditional asthma therapy. Conducting a systemic review of clinical trials, as well as using current asthma guidelines, their analysis spanned from September 1, 2024, to March 13, 2025.

The primary study outcome was annual asthma-related costs to health care payers.

“This US-based cost analysis of guideline-recommended SMART for asthma found that SMART was associated with reduced cumulative asthma management expenses for health care payers compared with traditional asthma treatment,” they wrote.¹ “Although SMART was associated with higher medication costs, reduced downstream morbidity lowered overall expenses.”

The model used in this cost analysis included 11,988 patients with asthma who participated in the trials mentioned previously. Overall, SMART demonstrated to be much more cost-effective than traditional therapies, predicted to save patients over $50 per year on asthma management costs. Furthermore, SMART treatment was cheaper in 57% of simulations and more cost-effective in 67%—exhibiting a “mean incremental net monetary” benefit for patients of $118 each year.

With SMART options for asthma treatment continuing to be limited, real-world evidence shows that it has the potential to significantly improve both outcomes and patient costs, only if developed and distributed properly regarding health care coverage, manufacturer costs, and most likely a slew of additional implications. However, further evidence on the benefit of SMART could increasingly bolster its use across the notably prominent population with moderate-to-severe asthma.

“Substantial gaps in guideline-recommended SMART coverage remain in the US, potentially contributing to preventable morbidity,” concluded the study authors.¹ “Given SMART’s demonstrated clinical benefit and its favorable cost profile observed in this analysis, expanding coverage represents a practical, evidence-based strategy to support improved asthma outcomes at the population level.”

READ MORE: Asthma Resource Center

Don’t get left behind: Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips delivered straight to your inbox.

REFERENCES

1. Pham T, Barker AR, Eisenstein SA, et al. Costs of single maintenance and reliever therapy vs traditional therapy for asthma. JAMA Netw Open. 2026;9(2):e2556757. doi:10.1001/jamanetworkopen.2025.56757

2. Evidence reviews for smart inhalers. National Institute for Health and Care Excellence. November 2024. Accessed February 3, 2026. https://www.ncbi.nlm.nih.gov/books/NBK611998/

3. Cost analysis of SMART therapy to improve asthma outcomes. American Lung Association. March 7, 2025. Accessed February 3, 2026. https://www.lung.org/blog/asthma-smart-therapy