Asthma hospitalization risk and costs for patients treated with fluticasone propionate vs montelukast

Background: Inhaled corticosteroids have been shown to reduce rates of hospitalization and emergency department use compared With leukotriene receptor antagonists. Objective: To examine differences in the probability of asthma-related hospitalizations, probability of switching or augmenting, with another therapy, and costs for patients treated with fluticasone propionate vs montelukast. Methods: The study involved a 24-month retrospective analysis of patients with claims for asthma treatment (primary diagnosis International Classification of Disease, Ninth Revision code of 493.xx) between January 1, 1997, and June 30, 2000, and at least 1 outpatient pharmaceutical claim for fluticasone propionate (44 mug) or montelukast (5 or 10 mg). Univariate and multivariate analyses were used to determine the probability of asthma-related hospitalizations and switching or augmenting to another therapy. asthma costs. and total health care costs. Sensitivity analyses were conducted by replicating all of the analyses by age strata (ages 4-17 years and greater than or equal to18 years) and varying lengths of follow-up. Results: Patients receiving fluticasone propionate had a 62% lower risk of experiencing an asthma-related hospitalization within I year and a 44% lower risk of switching or augmenting to another asthma controller medication compared with montelukast. Asthma-related health care expenditures for montelukast patients were $339 higher than for fluticasone propionate users (P <.001). Overall health care expenditures (asthma and nonasthma) were also $1,197 higher in the montelukast group. Conclusions: Compared with niontelukast-treated patients, patients treated with low-dose fluticasone propionate had a significantly lower risk of experiencing an asthma-related hospitalization, a lower risk of switching or augmenting with another controller, and significantly lower asthma and total health care costs.