title: Cost-effectiveness analysis of fluticasone versus montelukast in children with mild-to-moderate persistent asthma in the Pediatric Asthma Controller Trial.
abstract: BACKGROUND
  Cost-effectiveness analyses of asthma controller regimens for adults exist, but similar evaluations exclusively for children are few.
  
  
  OBJECTIVE
  We sought to compare the cost-effectiveness of 2 commonly used asthma controllers, fluticasone and montelukast, with data from the Pediatric Asthma Controller Trial.
  
  
  METHODS
  We compared the cost-effectiveness of low-dose fluticasone with that of montelukast in a randomized, controlled, multicenter clinical trial in children with mild-to-moderate persistent asthma. Analyses were also conducted on subgroups based on phenotypic factors. Effectiveness measures included (1) the number of asthma-control days, (2) the percentage of participants with an increase over baseline of FEV(1) of 12% or greater, and (3) the number of exacerbations avoided. Costs were analyzed from both a US health care payer's perspective and a societal perspective.
  
  
  RESULTS
  For all cost-effectiveness measures studied, fluticasone cost less and was more effective than montelukast. For example, fluticasone treatment cost $430 less in mean direct cost (P < .01) and resulted in 40 more asthma-control days (P < .01) during the 48-week study period. Considering sampling uncertainty, fluticasone cost less and was more effective at least 95% of the time. For the high exhaled nitric oxide (eNO) phenotypic subgroup (eNO ≥25 ppb) and more responsive PC(20) subgroup (PC(20) <2 mg/mL), fluticasone was cost-effective compared with montelukast for all cost-effectiveness measures, whereas not all the effectiveness measures were statistically different for the other 2 phenotypic subgroups.
  
  
  CONCLUSIONS
  For children with mild-to-moderate persistent asthma, low-dose fluticasone had lower cost and higher effectiveness compared with montelukast, especially in those with more airway inflammation, as indicated by increased levels of eNO and more responsivity to methacholine.
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. lwang@psu.edu
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: David T
authors.initials: DT
authors.lastname: Mauger
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paul
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Martinez
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Taussig
mesh_terms: D000085:Acetates / Q000191:economics* / Q000627:therapeutic use; 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; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D011804:Quinolines / Q000191:economics* / Q000627:therapeutic use; D012129:Respiratory Function Tests; D013440:Sulfides
chemical_list: D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast