Comparative Efficacy and Cost of Asthma Care in Children with Asthma Treated with Fluticasone Propionate and Montelukast

Objective

To assess the comparative efficacy of fluticasone propionate (FP) and montelukast (MON), using administrative claims for pediatric asthma in a clinical setting.

Study design

This retrospective observational study used the PharMetrics Integrated-Outcomes Database. Children age 4 to 17 years with an ICD-9-CM 493.xx for asthma, therapy with an inhaled corticosteroid in the 12 months before the index medications, and an index claim for FP or MON between January 2001 and December 2003 were studied. FP- and MON-treated children were propensity-matched based on health care utilization. Asthma-related parameters studied included treatment failure, hospitalizations, and total cost of care.

Results

The children treated with MON were more likely to experience treatment failure (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 2.19 to 2.96) and to be admitted to the hospital for asthma-related care (OR = 1.99; 95% CI = 1.15 to 3.44) compared with those treated with FP. Furthermore, the children treated with MON incurred significantly higher asthma-related treatment costs compared with those treated with FP (parameter estimate = 0.418; P < .0001).

Conclusions

In children with asthma, treatment with FP is associated with better outcomes and lower cost than treatment with MON.

Abbreviations: CI, Confidence interval, ED, Emergency department, FEV₁, Forced expiratory volume in 1 second, FP, Fluticasone proprionate, GINA, Global Initiative for Asthma, ICS, Inhaled corticosteroid, LABA, Long-acting beta agonist, LTRA, Leukotriene receptor antagonist, MON, Montelukast, NAEPP, National Asthma Education and Prevention Program, OCS, Oral corticosteroid, OR, Odds ratio, SABA, Short-acting beta agonist