Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone

Gene Colice, Richard J Martin, Elliot Israel, Nicolas Roche, Neil Barnes, Anne Burden, Peter Polos, Paul Dorinsky, Elizabeth V Hillyer, Amanda J. Lee, Alison Chisholm, Julie von Ziegenweidt, Francesca Barion, David Price

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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.
Original languageEnglish
Pages (from-to)45-54.e10
Number of pages20
JournalJournal of Allergy and Clinical Immunology
Volume132
Issue number1
Early online date13 Apr 2013
DOIs
Publication statusPublished - Jul 2013

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HFA 134a
Beclomethasone
Asthma
Costs and Cost Analysis
Adrenal Cortex Hormones
Databases
Therapeutics
Metered Dose Inhalers
Respiratory Rate
Fluticasone
Respiratory Tract Infections
Health Care Costs

Keywords

  • Asthma control
  • beclomethasone dipropionate
  • extrafine particle
  • fluticasone propionate
  • observational study
  • United States

Cite this

Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone. / Colice, Gene; Martin, Richard J; Israel, Elliot; Roche, Nicolas; Barnes, Neil; Burden, Anne; Polos, Peter; Dorinsky, Paul; Hillyer, Elizabeth V; Lee, Amanda J.; Chisholm, Alison; von Ziegenweidt, Julie; Barion, Francesca; Price, David.

In: Journal of Allergy and Clinical Immunology, Vol. 132, No. 1, 07.2013, p. 45-54.e10.

Research output: Contribution to journalArticle

Colice, G, Martin, RJ, Israel, E, Roche, N, Barnes, N, Burden, A, Polos, P, Dorinsky, P, Hillyer, EV, Lee, AJ, Chisholm, A, von Ziegenweidt, J, Barion, F & Price, D 2013, 'Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone', Journal of Allergy and Clinical Immunology, vol. 132, no. 1, pp. 45-54.e10. https://doi.org/10.1016/j.jaci.2013.02.008
Colice, Gene ; Martin, Richard J ; Israel, Elliot ; Roche, Nicolas ; Barnes, Neil ; Burden, Anne ; Polos, Peter ; Dorinsky, Paul ; Hillyer, Elizabeth V ; Lee, Amanda J. ; Chisholm, Alison ; von Ziegenweidt, Julie ; Barion, Francesca ; Price, David. / Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone. In: Journal of Allergy and Clinical Immunology. 2013 ; Vol. 132, No. 1. pp. 45-54.e10.
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AU - Martin, Richard J

AU - Israel, Elliot

AU - Roche, Nicolas

AU - Barnes, Neil

AU - Burden, Anne

AU - Polos, Peter

AU - Dorinsky, Paul

AU - Hillyer, Elizabeth V

AU - Lee, Amanda J.

AU - Chisholm, Alison

AU - von Ziegenweidt, Julie

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N2 - 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.

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