To assess the impact of combination therapy of inhaled corticosteroid plus montelukast (MON) or salmeterol (SAL) on asthma-related acute events [inpatient (IP) admissions and emergency department (ED) visits] and rescue medication use [oral corticosteroid (OCS) and short-acting beta-agonist (SABA)].
Using the PHARMetrics managed care claims database, patients on ICS therapy who added MON or SAL between 07/01/98 and 06/30/99 (index prescription) aged 4–55 years were identified. Patients with 12-month pre- and post-index observation time were included. The mean annual rate per 100 patients per year (claims) of asthma-related IP admissions, ED visits, OCS use and SABA use in the post-index period were analyzed. Poisson models were used to estimate rates of post-index asthma-related resource use, adjusting for propensity score, index treatment, comorbid conditions, pre-index resource use, and pre-index asthma costs.
3,171 patients on ICS initiated a second controller medication (MON=765, SAL=2406). A significant difference in post-index ED visits was observed (adjusted rate: ICS/SAL = 9 claims vs. ICS/MON=5 claims, p<.001) with an increase in rate among ICS/SAL patients (3 claims) and a decrease among ICS/MON patients (3 claims). A significantly greater adjusted post-index rate of claims for SABA use was found with use in ICS/MON patients (465 claims) compared to ICS/SAL (352 claims, p<.001). No significant difference between treatment groups was observed in adjusted post-index IP (ICS/MON=10.0 claims vs. ICS/SAL=10.5 claims; p=0.68) or adjusted post-index OCS use (ICS/SAL=45 claims vs. ICS/MON=53 claims, p=.06).
In this retrospective analysis, ICS/MON therapy was associated with lower rate of ED visits and a higher rate of SABA compared to ICS/SAL therapy. Similar rates of IP and OCS use were observed among patients in the two combination therapy groups.
The addition of Montelukast to ICS results in fewer ED visits while the addition of a long acting beta agonist such as Salmeterol to ICS results in less SABA use.
D. Anstatt, Merck & Co., Inc., Industry.