Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone

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• 作者：Gene Colice ; Richard J. Martin ; Elliot Israel ; Nicolas Roche ; Neil Barnes ; Anne Burden ; Peter Polos ; Paul Dorinsky ; Elizabeth V. Hillyer ; Am ; a J. Lee ; Alison Chisholm ; Julie von Ziegenweidt ; Francesca Barion ; David Price
• 关键词：Asthma control ; beclomethasone dipropionate ; extrafine particle ; fluticasone propionate ; observational study ; United States
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：132
• 期：1
• 页码：45-54.e10
• 全文大小：1790 K

文摘

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Background

Characteristics of inhaled corticosteroids (ICSs) differ, but data comparing the real-life effectiveness of various ICSs for asthma are lacking.

Objective

We sought to compare real-life asthma outcomes and costs of extrafine hydrofluoroalkane (HFA)-beclomethasone and fluticasone administered through a pressurized metered-dose inhaler.

Methods

This retrospective matched cohort study examined database markers of asthma control from a large US longitudinal health care claims database over 1 baseline and 1 outcome year for 10,312 patients with asthma aged 12 to 80 years receiving their first ICS as HFA-beclomethasone or fluticasone and matched on baseline demographic characteristics and asthma severity.

Results

Patients started on HFA-beclomethasone had significantly higher odds (adjusted odds ratio, 1.19; 95 % CI; 1.08-1.31) of achieving overall control (risk and impairment), which was defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection and less than 2 puffs per day of short-acting ¦Â-agonist; they also experienced a lower rate of respiratory-related hospitalizations or referrals (adjusted rate ratio, 0.82; 95 % CI, 0.73-0.93) than patients started on fluticasone. Other database outcome measures were similar in the 2 cohorts. Prescribed HFA-beclomethasone doses were lower (P?< .001) than fluticasone doses (median, 320 ¦Ìg/d [interquartile range, 160-320 ¦Ìg/d] vs 440 ¦Ìg/d [interquartile range, 176-440 ¦Ìg/d]). Adjusted respiratory-related health care costs were significantly lower for HFA-beclomethasone than fluticasone (mean, $1869 [95 % CI, $1727-$2032] vs $2259 [95 % CI, $2111-$2404]), representing a mean annual savings of $390 (95 % CI, $165-$620) per patient prescribed HFA-beclomethasone rather than fluticasone.

Conclusions

Asthma treatment outcomes were similar or better with HFA-beclomethasone prescribed at significantly lower doses and with lower costs than fluticasone.