Comparative effectiveness of budesonide inhalation suspension and montelukast in children with mild asthma in Korea

Abstract

Objective: The comparative effectiveness of low-dose budesonide inhalation suspension (BIS) versus oral montelukast (MON) in managing asthma control among children with mild asthma was assessed in Korea.

Methods: Claims from Korea’s national health insurance database for children (2–17 years) with mild asthma (GINA 1 or 2) who initiated BIS or MON during 2015 were retrospectively analyzed. Pre- and post-index windows were 1 year each. Adherence, persistency, asthma control, asthma-related health-care resource utilization, and costs were evaluated using unadjusted descriptive statistics and propensity score-matched regression analyses.

Results: The number of children identified was 26,052 for unmatched (n = 1,221 BIS; n = 24,831 MON) and 2,290 for matched populations (n = 1,145 per cohort). Medication adherence, measured by proportion of days covered, was low for both cohorts but significantly higher for MON versus BIS (13.8% vs. 4.5%; p < .001). Time to loss of persistency was longer for MON versus BIS (82.3 vs. 78.4 days, respectively; p < .001). Mean number of post-index asthma-related office visits was 6.6 for BIS versus 8.3 for MON (p < .001). However, a greater proportion of patients in the BIS cohort had an asthma exacerbation-related office visit than the MON cohort (78.3% vs. 56.1%; p < .001). Asthma-related total health-care costs were higher with MON versus BIS (₩ 190,185 vs. ₩ 167,432, respectively; p < .001), likely driven by higher pharmaceutical costs associated with MON (₩ 69,113 vs. ₩ 49,225; p < .001).

Conclusions: Montelukast patients had better adherence, a longer time to loss of persistency, and were less likely to experience an exacerbation-related office visit in the post-index period than BIS patients.

Keywords:

• Adherence
• persistency
• asthma control
• health-care resource utilization
• cost

Acknowledgements

Editorial assistance was provided by Erin P. Scott, PhD, of Scott Medical Communications. This assistance was funded by Merck & Co., Inc., Kenilworth, NJ, USA. The study sponsor participated in the design of the study, interpretation of the data, and writing of the manuscript. The first draft of the manuscript was written by Jina Shin, PharmD and S.H. Hong, PhD. All authors contributed to the writing of the manuscript and approved the manuscript for submission.

Declaration of interests

JS, SJO, SWP, and SHH have nothing to disclose. TP, KT, and EU are employees of Merck & Co., Inc., Kenilworth, NJ. PN and HF are paid consultants for Merck.

Additional information

Funding

Funding for this research was provided by Merck & Co., Inc., Kenilworth, NJ, USA.