Asthma: Resource use and costs for inhaled corticosteroid vs leukotriene modifier treatment—a meta-analysis

,

Original Research

Asthma: Resource use and costs for inhaled corticosteroid vs leukotriene modifier treatment—a meta-analysis

J Fam Pract. 2003 May;52(5):382-389

PDF Download

References

1. Janson S. National asthma education and prevention program, expert panel report. II: overview and application to primary care. Prim Care Pract 1998;2:578-588.

2. Lalloo UG, Bateman ED, Feldman C, et al. Guideline for the management of chronic asthma in adults—2000 update. South African Pulmonology Society Adult Asthma Working Group. S Afr Med J 2000;90:540-541-544-552.

3. Podell RN. National guidelines for the management of asthma in adults. Am Fam Physician 1992;46:1189-1196.

4. Veninga CC, Lagerlov P, Wahlstrom R, et al. Evaluating an educational intervention to improve the treatment of asthma in four European countries. Drug Education Project Group. Am J Respir Crit Care Med 1999;160:1254-1262.

5. Ozminkowski RJ, Wang S, Marder WD, Azzolini J, Schutt D. Cost implications for the use of inhaled anti-inflammatory medications in the treatment of asthma. Pharmacoeconomics 2000;18:253-264.

6. Paltiel AD, Fuhlbrigge AL, Kitch BT, et al. Cost-effectiveness of inhaled corticosteroids in adults with mild-to-moderate asthma: results from the asthma policy model. J Allergy Clin Immunol 2001;108:39-49.

7. Adams RJ, Fuhlbrigge A, Finkelstein JA, et al. Impact of inhaled antiinflammatory therapy on hospitalization and emergency department visits for children with asthma. Pediatrics 2001;107:706-711.

8. Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA 1997;277:887-891.

9. Dempsey OJ. Leukotriene receptor antagonist therapy. Postgrad Med J 2000;76:767-773.

10. Klingman D, Bielory L, Wang Y, et al. Asthma outcome changes associated with use of the leukotriene-receptor antagonist zafirlukast. Manag Care Interface 2001;14:62-66.

11. Price DB, Ben-Joseph RH, Zhang Q. Changes in asthma drug therapy costs for patients receiving chronic montelukast therapy in the U.K. Resp Med 2001;95:83-89.

12. Bleecker ER, Welch MJ, Weinstein SF, et al. Low-dose inhaled fluticasone propionate versus oral zafirlukast in the treatment of persistent asthma. J Allergy Clin Immunol 2000;105:1123-1129.

13. Ind PW. Inhaled corticosteroids versus anti-leukotrienes: a literature review on the clinical effects. Allergy 1999;54(suppl 50):43-46.

14. Malmstrom K, Rodriguez-Gomez G, Guerra J, et al. Oral montelukast, inhaled beclomethasone, and placebo for chronic asthma. A randomized, controlled trial. Montelukast/Beclomethasone Study Group. Ann Intern Med 1999;130:487-495.

15. Busse W, Nelson H, Wolfe J, Kalberg C, Yancey SW, Rickard KA. Comparison of inhaled salmeterol and oral zafirlukast in patients with asthma. J Allergy Clin Immunol 1999;103:1075-1080.

16. Stempel DA, Meyer JW, Stanford RH, Yancey SW. One-year claims analysis comparing inhaled fluticasone propionate with zafirlukast for the treatment of asthma. J Allergy Clin Immunol 2001;107:94-98.

17. Stempel DA, Mauskopf J, McLaughlin T, Yazdani C, Stanford RH. Comparison of asthma costs in patients starting fluticasone propionate compared to patients starting montelukast. Respir Med 2001;95:227-234.

18. Cook DJ, Guyatt GH, Ryan G, et al. Should unpublished data be included in meta-analyses? Current convictions and controversies. JAMA 1993;269:2749-2753.

19. McAuley L, Pham B, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 2000;356:1228-1231.

20. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-188.

21. Laird NM, Mosteller F. Some statistical methods for combining experimental results. Int J Technol Assess Health Care 1990;6:5-30.

22. Oates V, Gothard L. PEER Study: New Starts on Inhaled Corticosteroids or Leukotriene Modifiers in an Asthmatic Population. Advanced Paradigm and GlaxoWellcome, Inc. July 19, 2000. Information available from GlaxoSmithKline at 1-800-825-5249.

23. Pathak DS, Davis EA, Stanford RH. Economic impact of asthma therapy with fluticasone propionate, montelukast, or zafirlukast in a managed care population. Pharmacotherapy 2002;22:166-174.

24. Stanford R, Davis A, Edwards L, Kalberg C, Rickard K. The costs and efficacy of fluticasone propionate 88 mcg twice daily and montelukast 10 mg once daily in patients needing single controller therapy. Chest 2001;120:225S.-

25. White TJ, Gothard L, Fontes CL, Juzba M, Berenbeim DM, Gilderman AM. A Retrospective Administrative Healthcare Claims Analysis to Describe and Assess Pharmaceutical and Medical Resource Utilization within the PacifiCare CA Healthplan PROJECT 2: Longitudinal Analysis of Newly Diagnosed Asthmatics. Prescription Solutions/PacifiCare Health Systems and GlaxoWellcome Inc. November 27, 2000. Information available from GlaxoSmithKline at 1-800-825-5249.

26. Egger M, Smith GD. Meta-analysis bias in location and selection of studies. BMJ 1998;316:61-66.

27. Ebell MH. Prearrest predictors of survival following inhospital cardiopulmonary resuscitation: a meta-analysis. J Fam Pract 1992;34:551-558.

28. Poynard T, Moussalli J, Ratziu V, et al. Is antiviral treatment (IFN alpha and/or ribavirin) justified in cirrhosis related to hepatitis C virus? Societe Royale Belge de Gastroenterologie. Acta Gastroenterol Belg 1998;61:431-437.

29. Egger M, Schneider M, Smith GD. Meta-analysis spurious precision? Meta-analysis of observational studies. BMJ 1998;316:140-144.

However, observational data and retrospective analyses also have the advantage of reflecting “real world” treatment patterns and broader patient groups that increase the generalizability of the data, whereas clinical trials may include protocol-driven utilization and selected patient groups. Clinical trials also may occur in specialized health care settings, whereas observational (cohort) data may be more applicable to clinical practice. Due to these factors, meta-analysis of observational data has become common.²⁹

The pre-initiation vs post-initiation analysis indicated that values for each treatment group provide information on the similarities between treatment groups before initiation of controller therapy. Even though the treatment groups were not randomized to each therapy and we have no means to ensure compatibility between groups, having similar rates of resource use between groups provides some evidence regarding similarity. Nonetheless, given the limitations of the retrospective data and meta-analysis in general, it will be important to validate the results of this meta-analysis in the future with naturalistic prospective studies.

Despite these limitations, this study provides important information on the impact of asthma therapies on resource use and costs. Specifically, the resource use and cost outcomes assessed in this study were lower for inhaled corticosteroid patients than for leukotriene modifier patients. This study also illustrates the usefulness of metaanalysis in evaluating resource use and costs. By selecting and combining outcomes across studies in a standardized, rigorous, and transparent manner, the effects of different therapies can be evaluated with greater precision.

Acknowledgments

We thank John O’Donnell and Layne Gothard for their assistance with this manuscript.

Corresponding author
Michael T. Halpern, MD, PhD, Principal Scientist, Exponent, Inc., 1800 Diagonal Road, Alexandria, VA 22314. E-mail: mhalpern@exponent.com