Anti-inflammatory therapy reduces total costs of asthma care compared withbronchodilation: The Asthma Outcomes Registry

Background Current consensus guidelines recommend reliance on anti-inflamma tory drugs to treat asthma, reserving theophylline and other long-acting br onchodilators as adjuncts for patients whose symptoms are not well controll ed with antiinflammatory therapy. The effect of such recommendations on tot al costs of asthma cave has not yet been examined, however. Objective:To explore the relation between choice of maintenance therapy wit h anti-inflammatory agents vs long-acting bronchodilators and annual costs of asthma care using data from the Asthma Outcomes Registry. Methods: Patients 16 years and older were selected from the Asthma Outcomes Registry cohort if they had received either anti-inflammatories (inhaled c orticosteroids or cromones) or long-acting bronchodilators (theophylline, s almeterol, oral beta-agonists, or ipratropium bromide), but not both, for a t least 1 year before study entry. Oral corticosteroid-dependent patients, those with other chronic lung disease, and those with incomplete cost data during the 365 days before and after their enrollment in the Asthma Outcome s Registry (baseline and follow-up years) were excluded. The effect of anti inflammatory vs bronchodilator therapy was assessed by comparing the change (follow-up minus baseline) in total costs of asthma care. Results: A total of 314 patients met criteria for study inclusion (237 trea ted with anti-inflammatories and 77 treated with bronchodilators). Median c osts during the baseline year were similar in the anti-inflammatory and bro nchodilator groups ($341 and $335, respectively). In the follow-up year, th e median change in cost in the anti-inflammatory group was a decline of $93 compared with an increase of $76 in the bronchodilator group (P < .0001). This treatment effect was consistent across subgroups defined by age and am ount of medication consumed. Conclusions: These findings add support to current guidelines recommending reliance on anti-inflammatory therapy to control asthma. The emergence of n ew therapeutic agents to control inflammation may continue to reduce the co sts of treating this important disease.