title: Risk of asthma exacerbation, asthma-related health care utilization and costs, and adherence to controller therapy in patients with asthma receiving fluticasone propionate/salmeterol inhalation powder 100 μg/50 μg versus mometasone furoate inhalation powder.
abstract: OBJECTIVE
  National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as initial therapy in mild asthma patients. However, low doses of a fixed-dose combination of ICS and long-acting β-agonists are sometimes used. This study compares asthma-related outcomes and health care utilization and costs in clinical practice in patients starting fluticasone propionate 100 μg and salmeterol 50 μg via Diskus (FSC) or mometasone furoate (MF).
  
  
  METHODS
  A retrospective cohort study was conducted to compare asthma-related outcomes in asthma patients who received FSC or MF, using a large health insurance claims dataset spanning January 2004-December 2008. Patients with ≥1 claim with an asthma ICD-9-CM diagnosis code and ≥2 FSC or MF prescriptions were included, stratified into FSC or MF groups by study drug received first and matched using propensity score.
  
  
  RESULTS
  A total of 18,283 patients met inclusion criteria (14,044 FSC and 4239 MF); 3799 matched pairs were identified (mean follow-up: FSC 548 days, MF 537 days). FSC patients had lower risk of asthma-related exacerbation (Hazard ratio = 0.88, 95% CI 0.81-0.95, p = .002), defined as either asthma-related emergency department (ED) visits/hospitalizations or receipt of systemic corticosteroids (SCSs); fewer SCS claims (mean 0.28 vs. 0.33, p = .021); and fewer asthma-related physician office (PO) and hospital outpatient (HO) visits (mean 1.17 vs. 1.63, p < .001). However, asthma-related ED visits were higher with FSC (p = .004), and FSC patients had higher total costs of asthma-related health care ($953 vs. $862, p = .002).
  
  
  CONCLUSIONS
  In asthma patients initiating ICS therapy, MF had lower asthma-related ED visits. However, FSC may reduce the use of SCS and asthma-related PO/HO visits.
authors.affiliation: Policy Analysis Inc., Brookline, MA 02445, USA. mhagiwara@pai2.com
authors.forename: May
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: Richard H
authors.initials: RH
authors.lastname: Stanford
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D000730:Androstadienes / Q000008:administration & dosage* / Q000191:economics; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D004338:Drug Combinations; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000008:administration & dosage* / Q000191:economics; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000730:Androstadienes; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D000420:Albuterol