Asthma hospitalization risk and costs for patients treated with fluticasone propionate vs montelukast.
BACKGROUND
Inhaled corticosteroids have been shown to reduce rates of hospitalization and emergency department use compared with leukotriene receptor antagonists.


OBJECTIVE
To examine differences in the probability of asthma-related hospitalizations, probability of switching or augmentin, with another therapy, and costs for patients treated with fluticasone propionate vs montelukast.


METHODS
The study involved a 24-month retrospective analysis of patients with claims for asthma treatment (primary diagnosis International Classification of Disease, Ninth Revision code of 493.xx) between January 1, 1997, and June 30, 2000, and at least I outpatient pharmaceutical claim for fluticasone propionate (44 microg) or montelukast (5 or 10 mg). Univariate and multivariate analyses were used to determine the probability of asthma-related hospitalizations and switching or augmenting to another therapy, asthma costs, and total health care costs. Sensitivity analyses were conducted by replicating all of the analyses by age strata (ages 4-17 years and > or = 18 years) and varying lengths of follow-up.


RESULTS
Patients receiving fluticasone propionate had a 62% lower risk of experiencing an asthma-related hospitalization within 1 year and a 44% lower risk of switching or augmenting to another asthma controller medication compared with montelukast. Asthma-related health care expenditures for montelukast patients were dollar 339 higher than for fluticasone propionate users (P < .001). Overall health care expenditures (asthma and nonasthma) were also dollar 1,197 higher in the montelukast group.


CONCLUSIONS
Compared with montelukast-treated patients, patients treated with low-dose fluticasone propionate had a significantly lower risk of experiencing an asthma-related hospitalization, a lower risk of switching or augmenting with another controller, and significantly lower asthma and total health care costs.
Orsini
Lucinda
L
Medstat Inc, Cambridge, Massachusetts 02140, USA. lucinda.orsini@thomson.com
Limpa-Amara
Sasigaant
S
Crown
William H
WH
Stanford
Richard H
RH
Kamal
Khalid
K
D000085:Acetates / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D003521:Cyclopropanes; D005260:Female; D000068298:Fluticasone; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast