与其他哮喘控制疗法相比，丙酸氟替卡松和沙美特罗单一吸入器在儿童中的资源利用情况。

Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma.

作者信息

Stempel David A, Riedel Aylin Altan, Carranza Rosenzweig Jacqueline R

机构信息

Infomed NW and University of Washington, Seattle, WA, USA.

出版信息

Curr Med Res Opin. 2006 Mar;22(3):463-70. doi: 10.1185/030079906X89711.

DOI:10.1185/030079906X89711

PMID:16574030

Abstract

OBJECTIVE

To determine resource utilization in controller naïve children diagnosed with asthma receiving initial therapy with fluticasone propionate (FP) and salmeterol (SAL) in a single inhaler (FSC), FP alone, montelukast (MON), inhaled corticosteroid (ICS) + SAL from separate inhalers, or ICS + MON.

RESEARCH DESIGN AND METHODS

A retrospective, observational, 18-month (6-month pre-index and 12-month follow-up) database study using medical and pharmacy claims from a 5 million member managed care organization. Multivariate modeling was used to evaluate post-index resource utilization and asthma-related costs. Refill rates during the 12-month follow-up period were compared across cohorts.

RESULTS

The study included controller-naïve children (n = 9192) aged 4-17 years with an asthma diagnosis. Children treated with FSC were significantly less likely to receive additional prescriptions for short-acting beta-agonists compared with all other cohorts (p <or= 0.007) and oral corticosteroids compared with the MON, ICS + SAL, and ICS + MON cohorts (p <or= 0.009). Children receiving FSC were also significantly less likely to add another controller therapy compared with children started on FP alone, MON, or ICS + SAL (p <or= 0.001) and to receive care in an emergency department or hospital compared with children receiving ICS + MON (p < 0.001). The number of prescriptions for FSC in the 12-month post-index period was greater (p < 0.05) than the number of ICS claims in the FP, ICS + SAL, and ICS + MON cohorts. Compared with FSC, the adjusted total asthma-related post-index costs were greater (p <or= 0.008) in the MON and ICS + MON cohorts. Although adherence was greater with MON compared with FSC, MON was associated with less favorable clinical outcomes and greater resource utilization and costs.

CONCLUSION

FSC in children is associated with improved clinical outcomes and decreased resource utilization compared with other controller regimens.

摘要

目的

确定在一个单一吸入器中使用丙酸氟替卡松（FP）和沙美特罗（SAL）（FSC）、单独使用FP、孟鲁司特（MON）、来自不同吸入器的吸入性糖皮质激素（ICS）+SAL或ICS+MON对初治的哮喘患儿进行初始治疗时的资源利用情况。

研究设计与方法

一项回顾性观察性数据库研究，为期18个月（索引前6个月和随访12个月），使用来自一个拥有500万会员的管理式医疗组织的医疗和药房索赔数据。采用多变量建模来评估索引后资源利用情况和哮喘相关费用。比较各队列在12个月随访期内的再填充率。

结果

该研究纳入了4至17岁初治的哮喘患儿（n = 9192）。与所有其他队列相比，接受FSC治疗的患儿接受短效β-激动剂额外处方的可能性显著更低（p≤0.007），与MON、ICS+SAL和ICS+MON队列相比，接受口服糖皮质激素的可能性显著更低（p≤0.009）。与单独开始使用FP、MON或ICS+SAL的患儿相比，接受FSC治疗的患儿添加另一种控制治疗的可能性也显著更低（p≤0.001），与接受ICS+MON治疗的患儿相比，在急诊科或医院接受治疗的可能性显著更低（p < 0.001）。索引后12个月内FSC的处方数量比FP、ICS+SAL和ICS+MON队列中的ICS索赔数量更多（p < 0.05）。与FSC相比，MON和ICS+MON队列中索引后调整后的哮喘相关总费用更高（p≤0.008）。虽然与FSC相比，MON的依从性更高，但MON与较差的临床结局、更高的资源利用和费用相关。