After analyzing 18 months' worth of insurance claims data for three asthma medications, researchers found that the most effective of the medications cost nearly two to three times less than the other drugs.
Patients taking the asthma drug fluticasone propionate (sold under the brand name Flovent) had fewer hospitalizations, made fewer trips to the emergency room and had less of a need for additional medications to help control symptoms than did patients taking the other two drugs, said Dev Pathak, a study co-author and a professor of pharmacy at Ohio State University.
Fluticasone propionate is an inhaled corticosteroid - it reduces inflammation in tissues affected by asthma, namely nasal passages and bronchial tissues. The researchers compared fluticasone propionate to the drugs montelukast (Singulair) and zafirlukast (Accolate). Both belong to a class of drugs called leukotriene receptor blockers - drugs that help decrease the inflammation induced by asthma.
Although the National Heart, Lung and Blood Institute recommends that patients with mild, persistent asthma use inhaled corticosteroids (such as fluticasone propionate) as the first line of defense in controlling symptoms, many doctors don't consider it as a first treatment option.
But Pathak said they should.
"These findings confirm what clinical trials have already shown," he said. "While doctors have to decide what's best for their patients, we're not sure why, given its effectiveness, fluticasone propionate is not prescribed more often as the first step in treating mild asthma.
"It may be that doctors are comfortable prescribing a certain asthma medication, or that they aren't aware of the differences in cost and effectiveness between medications."
According to pharmaceutical data from 2001, Flovent prescriptions accounted for approximately 18.5 percent of all asthma medications prescribed to patients, while Singulair accounted for around 22.5 percent. Accolate was the least prescribed of the three medications, at a rate of about 3.8 percent.
Pathak conducted the research with Anne Davis and Richard Stanford, both with GlaxoSmithKline, the maker of Flovent and the study sponsor. The study appeared in a recent issue of the journal Pharmacotherapy.
The researchers collected medical and pharmacy claims data from four nationwide managed care plans. The study, which included 781 patients, covered an 18-month span split into two nine-month segments. Patient data was used only if the patient hadn't taken any of the three drugs for the first nine months, followed by nine months of using one of the prescribed medications.
"Our findings are based on real-world data," Pathak said. "We analyzed the data after doctors had already prescribed one of the three drugs to their patients."
Patient data was split into three groups, based on the drug prescribed: 284 patients used fluticasone propionate in either 0.044 or 0.110 milligram doses; 302 used montelukast in 5 and 10 milligram doses; and 195 used zafirlukast in 20 milligram doses. The latter two drugs were taken in tablet form.
The average total cost of asthma care for a patient using fluticasone propionate during the nine-month period was $528. The cost was nearly double for montelukast users ($967), and it nearly tripled for zafirlukast users ($1,359). Total cost included filling prescriptions, trips to doctors' offices and emergency rooms, hospitalizations and the need for additional medication to control asthma symptoms.
The use of fluticasone propionate was also linked to fewer hospitalizations and less of a need for additional medication to control asthma symptoms - the data showed that patients could get by longer on a regimen of fluticasone propionate alone.
"An inhaled corticosteroid, which fluticasone propionate is, should be considered the first line of therapy in patients with symptoms of mild asthma," Pathak said. "It seems to work better than the other two drugs and it also costs less."
Contact: Dev Pathak, (614) 688-3956; Pathak.1@osu.edu
Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu