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Chest ; 121(4): 1028-35, 2002 Apr.
Article in English | MEDLINE | ID: mdl-11948029

ABSTRACT

OBJECTIVE: To compare asthma-related health-care utilization and expenditures for patients prescribed one of three dual-controller therapies: fluticasone plus salmeterol, inhaled corticosteroids (ICS) [excluding fluticasone] plus salmeterol, and ICS plus a leukotriene modifier (LTM). MATERIALS AND METHODS: Asthma-related medical claims from two major health plans were obtained for the 12 months before and after the initiation of dual therapy. A total of 1,325 patients > or = 12 years old with no claims for COPD or respiratory tract cancer were selected from the approximately 3.5 million lives covered. Multivariable regression was used to assess differences in asthma-related expenditures. To compensate for positive skew, all cost variables were log-transformed. RESULTS: Risk-adjusted total asthma-related costs for the fluticasone-plus-salmeterol cohort (n = 121), the ICS-plus-salmeterol cohort (n = 844), and the ICS-plus-LTM cohort (n = 360) [corrected] were $975, $1,089, and $1,268, respectively. Risk-adjusted pharmacy costs were $813, $841, and $996, respectively. Generalized linear modeling, controlling for baseline covariates, indicated that compared to ICS-plus-LTM therapy, fluticasone-plus-salmeterol therapy was associated with a significant reduction in asthma-related total (p = 0.0014) and pharmacy (p = 0.001) costs. Similar results were found when the ICS-plus-salmeterol group and the ICS-plus-LTM group were compared (p = 0.0001). The number of inpatient, outpatient, and emergency department visits and their corresponding costs were lower for the fluticasone-plus-salmeterol cohort, but were not statistically significant (p > 0.05). CONCLUSION: Results from managed-care practice suggest that treatment with fluticasone plus salmeterol, and more broadly ICS plus salmeterol, yield important cost savings when compared to treatment with ICS plus LTM.


Subject(s)
Albuterol/analogs & derivatives , Albuterol/economics , Androstadienes/economics , Anti-Inflammatory Agents/economics , Asthma/economics , Health Expenditures/statistics & numerical data , Insurance, Physician Services/economics , Leukotriene Antagonists/economics , Administration, Inhalation , Administration, Topical , Adult , Albuterol/adverse effects , Albuterol/therapeutic use , Androstadienes/adverse effects , Androstadienes/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Asthma/drug therapy , Cost-Benefit Analysis/statistics & numerical data , Drug Therapy, Combination , Female , Fluticasone , Glucocorticoids , Humans , Leukotriene Antagonists/administration & dosage , Leukotriene Antagonists/adverse effects , Male , Middle Aged , Retrospective Studies , Salmeterol Xinafoate , Utilization Review
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