Costs and resource use of mild persistent asthma patients initiated on controller therapy.
BACKGROUND
The treatment of mild persistent asthma is controversial.


OBJECTIVE
A retrospective database approach was used to evaluate different alternatives to treating mild persistent asthma. We hypothesized that treatment with inhaled corticosteroids (ICS) would result in lowest costs than treatment with leukotriene modifiers (LM) and combination therapy with ICS long-acting inhaled beta(2)-agonists (LABA) because it would be associated with fewer acute care visits and hospitalizations than LM and it would have lower drug acquisition costs than both ICS+LABA and LM.


METHODS
Costs and resource utilization were compared in 1,283 mild persistent asthma patients initiating regular use of either ICS, ICS+LABA, or LM. Mild persistent asthma patients were identified from a privately insured claims database (1999-2005) using an established algorithm. Wilcoxon rank-sum tests and generalized linear models were used to compare costs.


RESULTS
Of the total patients who met study criteria, 319 patients (24.9%) initiated regular ICS use, 414 (32.3%) ICS+LABA use, and 550 (42.9%) LM use. Over the 1 year after controller therapy initiation, asthma-related direct costs were significantly lower with ICS compared with ICS+LABA or LM ($819 for ICS, $1,094 for ICS+LABA, and $869 for LM, p < 0.001 for all comparisons). There were no significant differences in resource use.


CONCLUSIONS
In this analysis, physicians, despite guideline recommendations, chose to treat patients with mild persistent asthma more often with LM and ICS+LABA than with ICS. However, therapy with ICS was less costly than treatment with either LM or ICS+LABA, primarily due to differences in drug costs, and provided similar outcomes.
Colice
Gene L
GL
The George Washington University School of Medicine and Washington Hospital Center, Washington, DC, USA.
Yu
Andrew P
AP
Ivanova
Jasmina I
JI
Hsieh
Matthew
M
Birnbaum
Howard G
HG
Lage
Maureen J
MJ
Brewster
Corrine
C
D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D020024:Leukotriene Antagonists / Q000191:economics / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists