Cost-efficacy analysis of fluticasone propionate versus zafirlukast in patients with persistent asthma

Objective: To compare the relative value of an inhaled corticosteroid, flut icasone propionate 88 mug twice daily, versus an oral leukotriene receptor antagonist, zafirlukast 20 mg twice daily, in patients with persistent asth ma currently receiving short acting beta (2)-agonists alone. Study design: A cost-efficacy analysis using resource utilisation and clini cal data obtained prospectively from a multicentre, randomised, double-blin d, double-dummy, placebo-controlled 12-week clinical trial conducted in the US. Perspective: Third-party payor. Patients and methods: A total of 451 corticosteroid-naive patients with per sistent asthma were treated with either fluticasone propionate 88 mug twice daily or zafirlukast 20 mg twice daily. All patients were given salbutamol (albuterol) to be used as rescue medication. Data were examined using inte nt-to-treat analysis. Results: Mean daily per person cost-efficacy ratios using improvement in fo rced expiratory volume in I second (FEV1) [greater than or equal to 12% inc rease from baseline] were $US3.47 for fluticasone propionate compared with $US7.81 for zafirlukast (1999 values). The mean daily per person cost-effic acy ratios for symptom-free days obtained were $US5.51 for fluticasone prop ionate compared with $US14.98 for zafirlukast. These cost-efficacy ratios r emained in favour of fluticasone propionate after a robust sensitivity anal ysis. Conclusions: Treatment with fluticasone propionate 88 tg twice daily was th e most cost effective treatment compared with zafirlukast 20 mg twice daily in this 12-week clinical trial. This analysis supports the use of fluticas one propionate 88 mug twice daily as first-line treatment in patients with persistent asthma previously treated with short-acting beta (2)-agonist alo ne.