Inhaled fluticasone propionate - A pharmacoeconomic review of its use in the management of asthma

Contemporary asthma management guidelines list inhaled corticosteroids as t he preferred controller medication for patients with persistent asthma. Des pite the availability of explicit guidelines, there is evidence that these agents are underused and that guidelines are not always adhered to. Fluticasone propionate is one of several inhaled corticosteroids used for t he treatment of asthma. Like other agents of its class, its efficacy is bac ked by extensive clinical data. More recently, the quality of life of recip ients of fluticasone propionate and its relative cost effectiveness have be en investigated. A series of comparative analyses show that inhaled fluticasone propionate i s more cost effective than oral zafirluliast and triamcinolone acetonide an d slightly more cost effective than flunisolide in adult patients with asth ma. Analyses used cost per symptom-free day and/or cost per successfully tr eated patient as outcome measures and were generally conducted from the per spective of the third-party payer. When administered at a microgram dose of half or less than budesonide (as is therapeutically appropriate), the cost effectiveness of fluticasone propionate was similar to or better than that of budesonide. In children, fluticasone propionate was more cost effective per treatment success compared with inhaled sodium cromoglycate. Quality-of-life assessments in patients with mild to moderate disease show that inhaled fluticasone propionate achieved improvements which were deemed to be clinically meaningful in patients with mild to moderate asthma; thes e changes were significantly greater than those achieved with oral zafirluk ast, inhaled triamcinolone acetonide or placebo. Greater improvements were evident with inhaled fluticasone propionate in patients with severe disease . Conclusions: In addition to the considerable body of clinical evidence supp orting the use of inhaled fluticasone propionate in patients with asthma, a ccumulating short term cost-effectiveness data also suggest that this agent can be administered for a similar or lower cost per outcome than other inh aled corticosteroids or oral zafirlukast. Importantly, the clinical benefit s offered by fluticasone propionate in patients with persistent asthma are accompanied by clinically significant improvements in quality of life.