Economic impact of asthma therapy with fluticasone propionate, montelukast, or zafirlukast in a managed care population.
OBJECTIVE
To compare asthma-related health care expenditures among patients newly prescribed fluticasone propionate 44 or 110 microg, montelukast 5 or 10 mg, or zafirlukast 20 mg.


METHODS
Retrospective cohort analysis of medical and pharmacy claims.


METHODS
University-affiliated health outcomes research center.


METHODS
Seven hundred eighty-one patients (aged > or = 4 yrs) with asthma treated with controller therapy for 9 months (postindex period), with no claim for an inhaled corticosteroid or leukotriene modifier in the previous 9 months (preindex period).


METHODS
Asthma-related medical and pharmacy data from insurance claims of four managed care plans (two Northeastern, one Midwestern, and one Western) were tabulated over the pre- and postindex periods.


RESULTS
Numbers of patients identified were 284 beginning fluticasone propionate; 302, montelukast; and 195, zafirlukast. Fluticasone propionate treatment was associated with significantly (p<0.001) lower risk-adjusted asthma-related charges compared with montelukast and zafirlukast treatment: $528, $967, and $1359, respectively In this cohort, fluticasone propionate also was associated with fewer hospitalizations, less need for additional controller agents, and longer maintenance on the index drug compared with montelukast and zafirlukast.


CONCLUSIONS
Based on these real-world data, as well as established national and international asthma guidelines, consideration should be given to inhaled corticosteroid therapy, particularly fluticasone propionate, for first-line, long-term effective management of asthma.
Pathak
Dev S
DS
Center for Health Outcomes, Policy, and Evaluation Studies, College of Medicine and Public Health, The Ohio State University, Columbus 43210-1234, USA.
Davis
E Anne
EA
Stanford
Richard H
RH
D000085:Acetates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007211:Indoles; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D048448:Phenylcarbamates; D011804:Quinolines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D007211:Indoles; D048448:Phenylcarbamates; D011804:Quinolines; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds; D000068298:Fluticasone; C093875:montelukast; C062735:zafirlukast