• Howard S Friedman and Barbara P Yawn.
• Analytic Solutions, LLC, New York, NY 10012, USA. Howard@analytic-consulting.com
• Curr Med Res Opin. 2007 Feb 1; 23 (2): 427-34.

BackgroundAsthma management guidelines recommend low-dose inhaled corticosteroids (ICS) for initial treatment of mild persistent asthma. Instead, data from primary care practice show that many patients start on combination therapy with fluticasone propionate/salmeterol (FPS) for mild asthma. The consequences of this variance from guideline recommendations are not well described.ObjectiveCompare healthcare utilization and asthma-related outcomes for patients with mild asthma who began treatment with FPS or ICS alone. Design and data source: A retrospective analysis of asthma-related insurance claims. Patients initially treated with FPS or ICS were identified from an administrative health insurance claims database and followed for 1 year. Analyses of resource utilization 6 months before therapy initiation identified patients with mild asthma. Propensity score matching managed between-group differences in clinical characteristics and controlled for selection bias.Outcome MeasuresResource use was determined for asthma-related outpatient visits, emergency room services, hospitalizations, and medications.ResultsDemographic characteristics and comorbidities were similar for each group (FPS, n = 1888; ICS, n = 1888). During the 12-month follow-up period, total asthma-related costs were significantly higher for FPS versus ICS (1206 vs. 804 dollars; p < 0.0001), owing primarily to significantly higher drug costs for FPS versus ICS (677 vs. 357 dollars; p < 0.0001). The percentage of patients experiencing an exacerbation (14.0% FPS, 13.5% ICS) and the average number of exacerbations in each group (0.175 FPS, 0.164 ICS) were similar.ConclusionsHealthcare costs were found to be lower in patients receiving ICS than in those receiving FPS, with similar health outcomes in both groups. Study limitations included the use of claims data and a proxy definition of asthma severity, and potential confounding by unobserved factors.

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