Asthma outcomes and costs of therapy with extrafine beclomethasone and fluticasone

J Allergy Clin Immunol. 2013 Jul;132(1):45-54. doi: 10.1016/j.jaci.2013.02.008. Epub 2013 Apr 13.

Abstract

Background: Characteristics of inhaled corticosteroids (ICSs) differ, but data comparing the real-life effectiveness of various ICSs for asthma are lacking.

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.

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.

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, oral corticosteroids, or antibiotics for lower respiratory tract infection and less than 2 puffs per day of short-acting β-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 < .001) than fluticasone doses (median, 320 μg/d [interquartile range, 160-320 μg/d] vs 440 μg/d [interquartile range, 176-440 μg/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.

Conclusions: Asthma treatment outcomes were similar or better with HFA-beclomethasone prescribed at significantly lower doses and with lower costs than fluticasone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Androstadienes / administration & dosage*
  • Anti-Asthmatic Agents / administration & dosage*
  • Asthma / drug therapy*
  • Beclomethasone / administration & dosage*
  • Bronchodilator Agents / administration & dosage*
  • Cohort Studies
  • Female
  • Fluticasone
  • Health Care Costs*
  • Humans
  • Hydrocarbons, Fluorinated / administration & dosage
  • Male
  • Metered Dose Inhalers
  • Middle Aged
  • Retrospective Studies

Substances

  • Androstadienes
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Hydrocarbons, Fluorinated
  • Fluticasone
  • Beclomethasone
  • apaflurane