Effects of fluticasone propionate/salmeterol combination on asthma-related health care resource utilization and costs and adherence in children and adults with asthma

Background: Clinical trials suggest that in patients with asthma inadequately controlled on low- to medium-dose inhaled corticosteroids (ICSs), the addition of a long-acting P-agonist such as salmeterol (SAL) is more effective than the addition of montelukast (MON) or a higher-dose ICS. Objective: This study was designed to expand on these earlier findings by comparing asthma-related health care resource utilization and costs, as well as adherence to ICSs, in children and adults with asthma receiving ICS monotherapy who either were switched to fluticasone propionate plus SAL from a single inhaler (FSC) or initiated add-on therapy with SAL from a separate inhaler or MON. Methods: This retrospective study used an integrated managed-care database from > 30 health plans. Patients were >= 5 years of age with a diagnosis of asthma (International Classification of Diseases, Ninth Revision, Clinical Modification 493.xx) and >= 2 claims for FSC, SAL, or MON. The date of first claim for the medication of interest was the index date. Patients were also required to have >= 1 claim for an ICS during the 12 months preindex and 12 months postindex. Utilization and costs of asthma-related care and adherence to ICS treatment postindex were compared using multivariate methods. Results: After adjusting for preindex characteristics, patients receiving FSC (n = 1287) had fewer claims for short-acting beta-agonists, oral corticosteroids, and lower adjusted asthma-related costs postindex compared with ICS + SAL (n = 562) and ICS + MON (n = 420). FSC patients also had greater adherence to ICS therapy. Those who received FSC had lower risks for treatment failure (defined as asthma-related emergency department visits or hospitalization or receipt of alternative study medication or oral corticosteroids during the postindex period). Conclusion: In this health insurance claims-based study of patients with asthma inadequately controlled with an ICS alone, those who received stepped-up therapy with FSC used fewer rescue medications and had greater persistence with ICSs compared with those in whom SAL or MON was added to ICS monotherapy.