Asthma-related health care resource use among patients starting fluticasone or montelukast therapy.
OBJECTIVE
To compare patterns of asthma-related health care resource use among patients prescribed fluticasone or montelukast as singlecontroller therapy for asthma, and to confirm patterns previously observed in retrospective analyses examining outcomes among patients receiving fluticasone or montelukast for asthma.


METHODS
Retrospective cohort study.


METHODS
Administrative claims data drawn from United States health insurers in 35 states, covering 17 million privately insured patients. PATIENTS; A total of 4758 patients aged 2-55 years with asthma who were prescribed either fluticasone or montelukast from July 1, 1998-June 30, 1999, were continuously enrolled for at least 24 months, had no evidence of controller therapy for 6 months before the start of drug therapy, and had no evidence of chronic obstructive pulmonary disease or other respiratory illness.


RESULTS
Patients were identified using an algorithm based on medical and pharmacy insurance claims. Patients were matched between groups based on a propensity score of clinical characteristics and age; this resulted in 1512 patients/treatment group. Asthma-related health care claims incurred for 12 months before and after the start of controller therapy were analyzed. After adjustment, the fluticasone-treated group had greater risk than the montelukast-treated group of requiring therapy with a short-acting beta-agonist in the follow-up period (relative risk 1.12, 95% confidence interval [CI] 1.03-1.20). Odds were similar across treatment groups for needing an emergency department visit and/or hospitalization (odds ratio 1.08, 95% CI 0.74-1.58) and for needing therapy with an oral corticosteroid (odds ratio 1.02, 95% CI 0.84-1.26).


CONCLUSIONS
The start of therapy with either fluticasone or montelukast as a single-controller for asthma was associated with similar asthma-related health care resource use in this matched population.
Allen-Ramey
Felicia C
FC
Outcomes Research and Management, Merck & Co., Inc., West Point, Pennsylvania 19486-0004, USA. felicia_ramey@merck.com
Anstatt
David T
DT
Sajjan
Shiva G
SG
Markson
Leona E
LE
D000085:Acetates / Q000191:economics* / Q000627:therapeutic use; D000293:Adolescent; 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*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D000068298:Fluticasone; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D013440:Sulfides
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast