Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone - 27/06/13
Abstract |
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 β-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 μg/d [interquartile range, 160-320 μg/d] vs 440 μg/d [interquartile range, 176-440 μg/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.
Le texte complet de cet article est disponible en PDF.Key words : Asthma control, beclomethasone dipropionate, extrafine particle, fluticasone propionate, observational study, United States
Abbreviations used : ED, HFA, ICS, LABA, MPR, pMDI, SABA, UK, US
Plan
| Supported by Teva Pharmaceuticals Limited of Petach Tikva, Israel. |
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| Disclosure of potential conflict of interest: G. Colice has been supported by one or more grants from Research in Real Life (RIRL); is a Board member for Merck, Ikana, Teva, MedImmune, and Dey; has consultancy arrangements with Teva, Prairie, and Dey; has provided expert testimony for Teva and Dey; has received one or more payments for lecturing from or is on the speakers' bureaus for Teva and Merck; and has received one or more payments for the development of educational presentations for CME Integrity. R. J. Martin has received support for travel from Teva; has consultancy arrangements with Merck, MedImmune, Graceway, Amgen, Sunovian, and Pearl; has received one or more grants from or has one or more grants pending with MedImmune and the National Heart, Lung, and Blood Institute; has received one or more payments for lecturing from or is on the speakers' bureaus for Merck, Graceway, and Genentech; and has received royalties from UpToDate. E. Israel has received one or more consulting fees or honoraria from, has received support for travel from, and has been provided with writing assistance, medicines, equipment, or administrative support by Teva; has consultancy arrangements with Abbott, Amgen, Cowen & Co, Infinity Pharmaceuticals, MedImmune (now AstraZeneca), Merck, newMentor, NKT Therapeutics, Ono Pharmaceuticals, Pulmatrix, Regeneron Pharmaceuticals, Schering Plough, Teva Specialty Pharmaceuticals, Agenzia Italiana del Farmico (AIFA), Gilead Sciences, and Johnson & Johnson; has provided expert testimony for Campbell, Campbell, Edwards & Conroy, Diedrich & Donohue, Ficksman & Conley, Gold & Gold, PA, Ryan Ryan Deluca LLP, and Sullway & Hollis; has received one or more grants from or has one or more grants pending with Aerovance, Amgen, i3 Research (Biota), Genentech, Icagen, MedImmune, and Novartis; has received one or more payments for lecturing from or is on the speakers' bureau for Genentech, Novartis, and Merck; and has received royalties from UpToDate. N. Roche has received support for travel from Teva; is a Board member for Chiesi, GlaxoSmithKline, Novartis, Nycomed, Mundipharma, Almirall, and Boehringer; has consultancy arrangements with GlaxoSmithKline, Chiesi, Novartis, Boehringer, Mundipharma, and Nycomed; has received one or more grants from or has one or more grants pending with Boehringer Ingelheim, Novartis, and Pfizer; has received one or more payments for lecturing from or is on the speakers' bureaus for GlaxoSmithKline, Chiesi, Novartis, Boehringer Ingelheim, Pfizer, Nycomed, Mundipharma, MEDA, MSD, and Teva; and has received one or more payments for the development of educational presentations for Novartis and for Nycomed. N. Barnes has been supported by one or more grants from and has received one or more consulting fees or honoraria from Teva; is a Board member for GlaxoSmithKline, Chiesi, Teva, Nycomed, NAPP, Mundipharma, and Novartis; has consultancy arrangements with GlaxoSmithKline, Chiesi, Teva, Nycomed, NAPP, Pfizer, Mundipharma, Novartis, Merck Sharp & Dohme, and Sandoz; and has received one or more grants from or has one or more grants pending with AstraZeneca and Novartis. A. Burden has received support for travel from, has received one or more fees for participation from, and has received one or more payments for writing or reviewing from Teva and has received one or more payments for manuscript preparation from Mundipharma, Teva, GlaxoSmithKline, Chiesi, Orion, Novartis, and Aerocrine. P. Dorinsky was a full-time employee of Teva at the time this work was conducted. E. V. Hillyer has received one or more consulting fees or honoraria from, has received one or more payments for writing or reviewing from, and has consultancy arrangements with RIRL; has received support for travel from Teva; and has received one or more payments for manuscript preparation from Merck, Teva France, and Aerocrine. A. J. Lee has received one or more consulting fees or honoraria from RIRL. A. Chisholm has received support for travel from, has received one or more fees for participation from, and has received one or more payments for writing or reviewing from Teva. J. von Ziegenweidt has received support for travel from, has received one or more fees for participation from, and has received one or more payments for writing or reviewing from Teva and has received one or more payments for manuscript preparation from Mundipharma, Teva, GlaxoSmithKline, Orion, Chiesi, Novartis, and Aerocrine. F. Barion has received support for travel from, has received one or more fees for participation from, and has received one or more payments for writing or reviewing from Teva and has received one or more payments for manuscript preparation from Teva and from Almirall. D. Price has been supported by one or more grants from, has received support for travel from, has received one or more fees for participation from, and has been provided with writing assistance, medicines, equipment, or administrative support by Teva; is a Board member for Almirral, Astra Zeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Mundipharma, Medapharma, Novartis, Napp, Nycomed, Pfizer, Sandoz, and Teva; has consultancy arrangements with Almirral, Astra Zeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Mundipharma, Medapharma, Novartis, Napp, Nycomed, Pfizer, Sandoz, and Teva; has received one or more grants from or has one or more grants pending with the UK National Health Service, Aerocrine, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Mundipharma, Novartis, Nycomed, Orion, Pfizer, and Teva; has received one or more payments for lecturing from or is on the speakers' bureaus for Almirral, AstraZeneca, Activaero, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Novartis, Merck, Mundipharma, Pfizer, and Teva; has received one or more payments for manuscript preparation from Mundipharma, Teva, Merck Sharp and Dohme; has one or more patents (planned, pending, or issued) with AKL Ltd; has received one or more payments for the development of educational presentations for GlaxoSmithKline; owns stock/stock options in AKL Ltd and is an owner of RIRL (80%); and has received one or more payments for travel/accommodations/meeting expenses from Mundipharma, Napp, Novartis and Boehringer Ingelheim. P. Polos declares that he has no relevant conflicts of interest. |
Vol 132 - N° 1
P. 45 - juillet 2013 Retour au numéro
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