Two-year retrospective economic evaluation of three dual-controller therapies used in the treatment of asthma.
OBJECTIVE
To compare asthma-related health-care utilization and expenditures for patients prescribed one of three dual-controller therapies: fluticasone plus salmeterol, inhaled corticosteroids (ICS) [excluding fluticasone] plus salmeterol, and ICS plus a leukotriene modifier (LTM).


METHODS
Asthma-related medical claims from two major health plans were obtained for the 12 months before and after the initiation of dual therapy. A total of 1,325 patients > or = 12 years old with no claims for COPD or respiratory tract cancer were selected from the approximately 3.5 million lives covered. Multivariable regression was used to assess differences in asthma-related expenditures. To compensate for positive skew, all cost variables were log-transformed.


RESULTS
Risk-adjusted total asthma-related costs for the fluticasone-plus-salmeterol cohort (n = 121), the ICS-plus-salmeterol cohort (n = 844), and the ICS-plus-LTM cohort (n = 360) [corrected] were $975, $1,089, and $1,268, respectively. Risk-adjusted pharmacy costs were $813, $841, and $996, respectively. Generalized linear modeling, controlling for baseline covariates, indicated that compared to ICS-plus-LTM therapy, fluticasone-plus-salmeterol therapy was associated with a significant reduction in asthma-related total (p = 0.0014) and pharmacy (p = 0.001) costs. Similar results were found when the ICS-plus-salmeterol group and the ICS-plus-LTM group were compared (p = 0.0001). The number of inpatient, outpatient, and emergency department visits and their corresponding costs were lower for the fluticasone-plus-salmeterol cohort, but were not statistically significant (p > 0.05).


CONCLUSIONS
Results from managed-care practice suggest that treatment with fluticasone plus salmeterol, and more broadly ICS plus salmeterol, yield important cost savings when compared to treatment with ICS plus LTM.
O'Connor
Richard D
RD
Sharp Rees Stealy Medical Center, San Diego, CA, USA.
O'Donnell
John C
JC
Pinto
Lionel A
LA
Wiener
Douglas J
DJ
Legorreta
Antonio P
AP
D000280:Administration, Inhalation; D000287:Administration, Topical; D000328:Adult; D000420:Albuterol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D000730:Androstadienes / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007357:Insurance, Physician Services / Q000191:economics*; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000068299:Salmeterol Xinafoate; D014600:Utilization Review
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D020024:Leukotriene Antagonists; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol