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(Chest. 2002;121:1028-1035.)
© 2002 American College of Chest Physicians

Two-Year Retrospective Economic Evaluation of Three Dual-Controller Therapies Used in the Treatment of Asthma*

Richard D. O’Connor, MD; John C. O’Donnell, MA, PhD; Lionel A. Pinto, MS; Douglas J. Wiener, MD and Antonio P. Legorreta, MD, MPH

* From the Sharp Rees Stealy Medical Center (Dr. O’Connor), San Diego, CA; GlaxoSmithKline (Dr. O’Donnell), Research Triangle Park, NC; Health Benchmarks (Mr. Pinto and Dr. Wiener), Woodland Hills, CA; and Department of Health Services (Dr. Legorreta), School of Public Health, The University of California, Los Angeles, CA.

Correspondence to: Antonio P. Legorreta MD, MPH, Health Benchmarks, 21650 Oxnard St, Suite 2150, Woodland Hills CA 91367; e-mail: alegorreta{at}healthbenchmarks.com

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 >= 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 = 30) 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.

Key Words: asthma • dual-controller therapy • fluticasone • inhaled corticosteroids • leukotriene modifiers • pharmacoeconomic evaluation • salmeterol






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