Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma

ABSTRACT

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.

Research design and 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 ≤ 0.007) and oral corticosteroids compared with the MON, ICS + SAL, and ICS + MON cohorts ( p ≤ 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 ≤ 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 ≤ 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.

Conclusion: FSC in children is associated with improved clinical outcomes and decreased resource utilization compared with other controller regimens.

Key words: :

• Asthma
• Childhood asthma
• Children
• Fluticasone propionate
• Inhaled corticosteroids
• Montelukast
• Salmeterol

Notes

* These data were presented in part at the American College of Asthma, Allergy & Immunology 2004 Annual Meeting; Boston, MA; November 12-17, 2004