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Pharmacoeconomics in Pediatric Asthma

R. Andrew McIvor, MD, MSc
Author and Funding Information

Affiliations: Halifax, Nova Scotia, Canada 
 ,  Dr. McIvor is Associate Professor of Medicine, Dalhousie University, and Staff Respirologist, Queen Elizabeth II Health Sciences Centre.

Correspondence to: R. Andrew McIvor, MD, MSc, Staff Respirologist, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Room 4479, Halifax, Nova Scotia, Canada B3H 3A7; e-mail: amcivor@is.dal.ca



Chest. 2001;120(6):1762-1763. doi:10.1378/chest.120.6.1762
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In Canada throughout the 1990s, inhaled corticosteroids (ICS) have been the treatment of choice, and we continue to view ICS as the mainstay of treatment for persistent asthma in children, except for those whose disease is so mild that they only require infrequent, as-needed β2-agonist treatment.1 Corticosteroid dosage should continue to be individualized, and the minimum effective dose should be used.

In this issue of CHEST (see page 1835), Bisgaard et al present a retrospective pharmacoeconomic analysis based on their recent randomized controlled trial of asthma therapy in infants and toddlers with an average age of 28 months. This study reports that the percentage of patients with one or more exacerbations was significantly lower in those treated with fluticasone, 200 μg/d (20%) or 100μ g/d (26%), than in those treated with placebo (37%), and was accompanied by significant improvements in overall asthma control in both active treatment groups.2 The dose-response curve for fluticasone administered through a spacer (Babyhaler; Glaxo Wellcome; Middlesex, UK) was, however, relatively flat. Not so long ago, this dramatic reduction in exacerbations would have been enough to ensure not only approval of the product but formulary coverage. Now we have to go one step further and formally assess the study outcomes from a pharmacoeconomic standpoint.3

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