Cost-effectiveness analysis of fluticasone versus montelukast in children with mild-to-moderate persistent asthma in the Pediatric Asthma Controller Trial - 10/08/11
, Christopher S. Hollenbeak, PhD a, b, David T. Mauger, PhD a, Robert S. Zeiger, MD, PhD c, d, Ian M. Paul, MD, MSc a, e, Christine A. Sorkness, PharmD f, Robert F. Lemanske, MD g, Fernando D. Martinez, MD h, Robert C. Strunk, MD i, Stanley J. Szefler, MD j, Lynn M. Taussig, MD jChildhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute
Reprint requests: Li Wang, PhD, Penn State College of Medicine, Department of Public Health Sciences, A210, Hershey, PA 17033.Abstract |
Background |
Cost-effectiveness analyses of asthma controller regimens for adults exist, but similar evaluations exclusively for children are few.
Objective |
We sought to compare the cost-effectiveness of 2 commonly used asthma controllers, fluticasone and montelukast, with data from the Pediatric Asthma Controller Trial.
Methods |
We compared the cost-effectiveness of low-dose fluticasone with that of montelukast in a randomized, controlled, multicenter clinical trial in children with mild-to-moderate persistent asthma. Analyses were also conducted on subgroups based on phenotypic factors. Effectiveness measures included (1) the number of asthma-control days, (2) the percentage of participants with an increase over baseline of FEV1 of 12% or greater, and (3) the number of exacerbations avoided. Costs were analyzed from both a US health care payer’s perspective and a societal perspective.
Results |
For all cost-effectiveness measures studied, fluticasone cost less and was more effective than montelukast. For example, fluticasone treatment cost $430 less in mean direct cost (P < .01) and resulted in 40 more asthma-control days (P < .01) during the 48-week study period. Considering sampling uncertainty, fluticasone cost less and was more effective at least 95% of the time. For the high exhaled nitric oxide (eNO) phenotypic subgroup (eNO ≥25 ppb) and more responsive PC20 subgroup (PC20 <2 mg/mL), fluticasone was cost-effective compared with montelukast for all cost-effectiveness measures, whereas not all the effectiveness measures were statistically different for the other 2 phenotypic subgroups.
Conclusion |
For children with mild-to-moderate persistent asthma, low-dose fluticasone had lower cost and higher effectiveness compared with montelukast, especially in those with more airway inflammation, as indicated by increased levels of eNO and more responsivity to methacholine.
Le texte complet de cet article est disponible en PDF.Key words : Cost-effectiveness analysis, childhood asthma, fluticasone, montelukast, Pediatric Asthma Controller Trial
Abbreviations used : ACD, CEA, DPI, eNO, ICER, MDI, PACT, WTP
Plan
| Supported by grants 5U10HL064287, 5U10HL064288, 5U10HL064295, 5U10HL064307, 5U10HL0643055, and 5U10HL064313 from the National Heart, Lung, and Blood Institute. This study was carried out in part in the General Clinical Research Centers at Washington University School of Medicine (M01 RR00036) and National Jewish Health and University of Colorado Denver School of Medicine (M01 RR00051) under Colorado CTSA grant 1 UL1 RR025780 from NCRR/HIH. |
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| Disclosure of potential conflict of interest: D. T. Mauger has received research support from GlaxoSmithKline. R. S. Zeiger is a consultant for Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, MedImmune, Merck, and Sunovion and has received research support from Aerocrine, Genentech, GlaxoSmithKline, and Merck. C. A. Sorkness is a consultant for GlaxoSmithKline, AstraZeneca, and Novartis and has received research support from Schering-Plough, Pharmaxis, Sandoz/Compleware, and the National Heart, Lung, and Blood Institute (NHLBI). R. F. Lemanske is a speaker for Merck, Washington University, the Medicus Group, the Park Nicolet Institute, the ACAAI (American College of Allergy, Asthma & Immunology), the LA Allergy Society, the Michigan Allergy/Asthma Society, the Medical College of Wisconsin, the Fund for Medical Research and Education (Detroit), Children’s Hospital of Minnesota, the Toronto Allergy Society, the AAAAI (American Academy of Allergy, Asthma & Immunology), Beaumont Hospital (Detroit), the University of Illinois, the Canadian Society of Allergy and Clinical Immunology, and New York Presbyterian; is a consultant and speaker for AstraZeneca; is a consultant for Map Pharmaceuticals, Gray Consulting, Smith Research, the Merck Childhood Asthma Network, Novartis, Quintiles/Innovax, RC Horowitz & Co, International Meetings and Science, and Scienomics; is the author of Up-to-Date; and is a textbook editor for Elsevier. F. D. Martinez is on the advisory board for and receives lecture fees from Merck; is a consultant for GlaxoSmithKline and MedImmune; receives lecture fees from Pfizer; and has received research support from the National Institutes of Health. S. J. Szefler is a consultant for GlaxoSmithKline, Genentech, Merck, Boehringer-Ingelheim, Novartis, and Schering-Plough and has received research support from the National Institutes of Health (NIH)/NHLBI’s Childhood Management Program, the NHLBI’s Childhood Asthma Research and Education, NIH/NHLBI’s Asthma Clinical Research Network, the NIH/NIAID’s Inner City Asthma Consortium, GlaxoSmithKline, NIH/NHLBI Asthma Met, and a National Institute of Environmental Health Sciences/US Environmental Protection Agency Childhood Environmental Health Center grant. The rest of the authors have declared that they have no conflict of interest. |
Vol 127 - N° 1
P. 161 - janvier 2011 Retour au numéro
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