Fluticasone is associated with lower asthma-related costs than leukotriene modifiers in a real-world analysis.
OBJECTIVE
To compare the impact of fluticasone propionate versus three leukotriene modifiers-montelukast, zafirlukast, and zileuton-on the cost of asthma within a managed care organization.


METHODS
Retrospective quasi-experimental comparison.


METHODS
Managed care organization with approximately 350,000 enrollees.


METHODS
Three hundred forty-seven patients with asthma who received at least two prescriptions for either fluticasone or a leukotriene modifier. Patients receiving both fluticasone and a leukotriene modifier were excluded.


RESULTS
Multivariate analysis was used to compare total asthma-related costs between treatment groups. A significant difference in total asthma-related costs was found between patients receiving fluticasone (adjusted mean cost $511) compared with those receiving a leukotriene modifier ($1,092; p=0.0001). Other significant predictors of postindex asthma-related costs were pre-index asthma-related costs, a severity adjustment score, and the diagnosis of chronic obstructive pulmonary disease. Patients taking a leukotriene modifier obtained more short-acting beta-agonists than patients receiving fluticasone (6.49 +/- 4.05 vs 4.30 +/- 3.41, p < 0.0001). A survival analysis of time to receive any additional controller therapy revealed that patients receiving fluticasone were significantly less likely to receive another controller than were those receiving a leukotriene modifier (p=0.0014).


CONCLUSIONS
These results suggest that fluticasone is associated with lower asthma-related costs than leukotriene modifiers.
Armstrong
Edward P
EP
College of Pharmacy, University of Arizona, Tucson 85721, USA.
Malone
Daniel C
DC
D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D000730:Androstadienes / Q000191:economics* / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001130:Arizona; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D000068298:Fluticasone; D006801:Humans; D020024:Leukotriene Antagonists / Q000191:economics* / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics; D012189:Retrospective Studies; D016019:Survival Analysis
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists; D000068298:Fluticasone