Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone

作者：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^*

来源：Journal of Allergy and Clinical Immunology, 2013, 132(1): 45-U102.

DOI：10.1016/j.jaci.2013.02.008

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

Background: Characteristics of inhaled corticosteroids (ICSs) differ, but data comparing the real-life effectiveness of various ICSs for asthma are lacking. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;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, oralcorticosteroids, or antibiotics for lower respiratory tract infection and less than 2 puffs per day of short-acting beta-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 %26lt;.001) than fluticasone doses (median, 320 mu g/d [interquartile range, 160320 mg/d] vs 440 mg/d [interquartile range, 176-440 mg/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. %26lt;br%26gt;Conclusions: Asthma treatment outcomes were similar or better with HFA-beclomethasone prescribed at significantly lower doses and with lower costs than fluticasone.

• 出版日期2013-7