Comparison of prevalence, cost, and outcomes of a combination of salmeterol and fluticasone therapy to common asthma treatments

Objectives: To compare a combination of salmeterol and fluticasone with com mon asthma pharmacologic regimens used in real-world clinical practice, and to evaluate the associated costs and outcomes of care. Study Design: Cross-sectional examination of medical, and pharmacy claims. Methods: The study population included 33,939 adult asthmatics (at least 12 years of age) continuously enrolled in 1 of 4 participating health plans f or the 6-month study period. Every subject was in 1 of 10 different pharmac otherapy treatment groups. Univariate and multivariate analyses were used t o compare the rates and costs of pharmaceutical prescriptions and medical c are services between patients on salmeterol plus fluticasone and patients w ith other pharmacologic therapies, Results: About 60.4% of the patients were on single controllers; the balanc e was on short-acting beta (2)-agonists alone (23%) or double controllers ( 16.8%). The average overall cost of asthma care was approximately $228 per patient over the 6 months of the study. Pharmaceutical cost was the major c ost driver, which was significantly lower for single-controller (mean = $13 4) than for double-controller therapies (mean = $325). However, total costs were $50-$200 lower (P < .029) for patients on salmeterol plus fluticasone and inhaled steroids plus mast cell stabilizing agents than for those on o ther double controllers. Conclusions: Single-controller regimens and short-acting beta -agonists wer e less costly than double-controller regimens. Within the double-controller groups, salmeterol plus fluticasone appeared to be less costly than other double controllers, except inhaled steroids plus mast cell stabilizing agen ts.