title: Inhaled corticosteroids plus salmeterol or montelukast: effects on resource utilization and costs.
abstract: BACKGROUND
  Experimental clinical studies have demonstrated that the addition of salmeterol to inhaled corticosteroids (ICSs) is superior to the addition of montelukast to ICSs. Observational research from real-world clinical practice is needed to confirm these results.
  
  
  OBJECTIVE
  The present study was designed to assess, in clinical practice, the comparative impact on health care utilization and cost of 2 dual-controller therapies, ICS + salmeterol and ICS + montelukast.
  
  
  METHODS
  This study involved the use of a 24-month pre/post retrospective design in patients continuously enrolled in any of 14 United HealthCare plans. Outcomes assessed were post-index pharmacy costs, rates of emergency department visits and hospitalizations, numbers of filled prescriptions for short-acting beta-agonists (SABAs), total asthma costs, and total health care costs.
  
  
  RESULTS
  Subjects in the ICS + salmeterol group had 35% fewer post-index SABA claims than subjects in the montelukast add-on group (P <or=.05). Subjects using ICS + montelukast were 2.5 times more likely to have an asthma-related hospitalization than subjects using ICS + salmeterol (P <or=.065). Total adjusted asthma costs were 63% higher for the patients receiving ICS + montelukast than for the patients receiving ICS + salmeterol (P <or=.0001). In addition, total health care costs were 25% lower in the ICS + salmeterol group. (P <or=.0004). Additional reductions in hospitalization and emergency department visits were observed when the patients on FP + salmeterol were studied separately.
  
  
  CONCLUSIONS
  In comparison with the use of montelukast and ICS, the use of salmeterol and ICS was associated with a significant reduction in SABA use, decreased hospital event rates, and significantly lower total asthma care costs.
authors.affiliation: Virginia Mason Clinic, Seattle, WA 98101, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Stempel
authors.forename: John C
authors.initials: JC
authors.lastname: O'Donnell
authors.forename: Jay W
authors.initials: JW
authors.lastname: Meyer
mesh_terms: D000085:Acetates / Q000191:economics / Q000627:therapeutic use*; D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000420:Albuterol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use*; D000068299:Salmeterol Xinafoate; D013440:Sulfides
chemical_list: D000085:Acetates; D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068299:Salmeterol Xinafoate; C093875:montelukast; D000420:Albuterol