Economic impact of asthma therapy with fluticasone propionate, montelukast, or zafirlukast in a managed care population

Study Objective. To compare asthma-related health care expenditures among patients newly prescribed fluticasone propionate 44 or 110 mug, montelukast 5 or 10 mg, or zafirlukast 20 mg. Design. Retrospective cohort analysis of medical and pharmacy claims. Setting. University-affiliated health outcomes research center. Patients. Seven hundred eighty-one patients (aged greater than or equal to 4 yrs) with asthma treated with controller therapy for 9 months (postindex period), with no claim for an inhaled corticosteroid or leukotriene modifier in the previous 9 months (preindex period). Intervention. Asthma-related medical and pharmacy data from insurance claims of four managed care plans (two Northeastern, one Midwestern, and one Western) were tabulated over the pre- and postindex periods. Measurements and Main Results. Numbers of patients identified were 284 beginning fluticasone propionate; 302, montelukast; and 195, zafirlukast. Fluticasone propionate treatment was associated with significantly (p<0.001) lower risk-adjusted asthma-related charges compared with montelukast and zafirlukast treatment: $528, $967, and $1359, respectively. In this cohort, fluticasone propionate also was associated with fewer hospitalizations, less need for additional controller agents, and longer maintenance on the index drug compared with montelukast and zafirlukast. Conclusions. Based on these real-world data, as well as established national and international asthma guidelines, consideration should be given to inhaled corticosteroid therapy, particularly fluticasone propionate, for first-line, long-term effective management of asthma.