title: Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone.
abstract: BACKGROUND
  Characteristics of inhaled corticosteroids (ICSs) differ, but data comparing the real-life effectiveness of various ICSs for asthma are lacking.
  
  
  OBJECTIVE
  We sought to compare real-life asthma outcomes and costs of extrafine hydrofluoroalkane (HFA)-beclomethasone and fluticasone administered through a pressurized metered-dose inhaler.
  
  
  METHODS
  This retrospective matched cohort study examined database markers of asthma control from a large US longitudinal health care claims database over 1 baseline and 1 outcome year for 10,312 patients with asthma aged 12 to 80 years receiving their first ICS as HFA-beclomethasone or fluticasone and matched on baseline demographic characteristics and asthma severity.
  
  
  RESULTS
  Patients started on HFA-beclomethasone had significantly higher odds (adjusted odds ratio, 1.19; 95% CI; 1.08-1.31) of achieving overall control (risk and impairment), which was defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection and less than 2 puffs per day of short-acting β-agonist; they also experienced a lower rate of respiratory-related hospitalizations or referrals (adjusted rate ratio, 0.82; 95% CI, 0.73-0.93) than patients started on fluticasone. Other database outcome measures were similar in the 2 cohorts. Prescribed HFA-beclomethasone doses were lower (P < .001) than fluticasone doses (median, 320 μg/d [interquartile range, 160-320 μg/d] vs 440 μg/d [interquartile range, 176-440 μg/d]). Adjusted respiratory-related health care costs were significantly lower for HFA-beclomethasone than fluticasone (mean, $1869 [95% CI, $1727-$2032] vs $2259 [95% CI, $2111-$2404]), representing a mean annual savings of $390 (95% CI, $165-$620) per patient prescribed HFA-beclomethasone rather than fluticasone.
  
  
  CONCLUSIONS
  Asthma treatment outcomes were similar or better with HFA-beclomethasone prescribed at significantly lower doses and with lower costs than fluticasone.
authors.affiliation: Washington Hospital Center and George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Colice
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.forename: Neil
authors.initials: N
authors.lastname: Barnes
authors.forename: Anne
authors.initials: A
authors.lastname: Burden
authors.forename: Peter
authors.initials: P
authors.lastname: Polos
authors.forename: Paul
authors.initials: P
authors.lastname: Dorinsky
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Hillyer
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Alison
authors.initials: A
authors.lastname: Chisholm
authors.forename: Julie
authors.initials: J
authors.lastname: von Ziegenweidt
authors.forename: Francesca
authors.initials: F
authors.lastname: Barion
authors.forename: David
authors.initials: D
authors.lastname: Price
mesh_terms: D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D000068298:Fluticasone; D017048:Health Care Costs; D006801:Humans; D006845:Hydrocarbons, Fluorinated / Q000008:administration & dosage; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D012189:Retrospective Studies; D005466:Fluorocarbons
chemical_list: D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D001507:Beclomethasone; D001993:Bronchodilator Agents; D000068298:Fluticasone; D006845:Hydrocarbons, Fluorinated; C094049:apaflurane; D005466:Fluorocarbons