title: Two-year retrospective economic evaluation of three dual-controller therapies used in the treatment of asthma.
abstract: 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.
authors.affiliation: Sharp Rees Stealy Medical Center, San Diego, CA, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: O'Connor
authors.forename: John C
authors.initials: JC
authors.lastname: O'Donnell
authors.forename: Lionel A
authors.initials: LA
authors.lastname: Pinto
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiener
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Legorreta
mesh_terms: 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
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D020024:Leukotriene Antagonists; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol