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Wednesday 01 March 2006

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

By: Stempel DA, Riedel AA, Carranza Rosenzweig JR.

Curr Med Res Opin 2006 Mar;22(3):463-70

OBJECTIVE: To determine resource utilization in controller naive 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-naive 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 <or= 0.007) and oral corticosteroids compared with the MON, ICS + SAL, and ICS + MON cohorts (p <or= 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 <or= 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 <or= 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.

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