Inhaled corticosteroids plus salmeterol or montelukast: effects on resource utilization and costs.
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.
Stempel
David A
DA
Virginia Mason Clinic, Seattle, WA 98101, USA.
O'Donnell
John C
JC
Meyer
Jay W
JW
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
D000085:Acetates; D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068299:Salmeterol Xinafoate; C093875:montelukast; D000420:Albuterol