Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma.
OBJECTIVE
To determine resource utilization in controller naïve children diagnosed with asthma receiving initial therapy with fluticasone propionate (FP) and salmeterol (SAL) in a single inhaler (FSC), FP alone, montelukast (MON), inhaled corticosteroid (ICS) + SAL from separate inhalers, or ICS + MON.


METHODS
A retrospective, observational, 18-month (6-month pre-index and 12-month follow-up) database study using medical and pharmacy claims from a 5 million member managed care organization. Multivariate modeling was used to evaluate post-index resource utilization and asthma-related costs. Refill rates during the 12-month follow-up period were compared across cohorts.


RESULTS
The study included controller-naïve children (n = 9192) aged 4-17 years with an asthma diagnosis. Children treated with FSC were significantly less likely to receive additional prescriptions for short-acting beta-agonists compared with all other cohorts (p <or= 0.007) and oral corticosteroids compared with the MON, ICS + SAL, and ICS + MON cohorts (p <or= 0.009). Children receiving FSC were also significantly less likely to add another controller therapy compared with children started on FP alone, MON, or ICS + SAL (p <or= 0.001) and to receive care in an emergency department or hospital compared with children receiving ICS + MON (p < 0.001). The number of prescriptions for FSC in the 12-month post-index period was greater (p < 0.05) than the number of ICS claims in the FP, ICS + SAL, and ICS + MON cohorts. Compared with FSC, the adjusted total asthma-related post-index costs were greater (p <or= 0.008) in the MON and ICS + MON cohorts. Although adherence was greater with MON compared with FSC, MON was associated with less favorable clinical outcomes and greater resource utilization and costs.


CONCLUSIONS
FSC in children is associated with improved clinical outcomes and decreased resource utilization compared with other controller regimens.
Stempel
David A
DA
Infomed NW and University of Washington, Seattle, WA, USA. econmed@msn.com
Riedel
Aylin Altan
AA
Carranza Rosenzweig
Jacqueline R
JR
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008329:Managed Care Programs; D009330:Nebulizers and Vaporizers; D012189:Retrospective Studies; D000068299:Salmeterol Xinafoate; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol