Cost of asthma rescue and anti-allergy medications among asthmatic children with prior anti-allergy prescriptions initiating asthma controller therapy

Abstract

Rationale Evaluate the effect of asthma-controller initiation (montelukast [MON] vs. inhaled corticosteroids [ICS]) on asthma-rescue and anti-allergy medication costs among children with asthma and allergic rhinitis [AR]. Methods A 24-month retrospective, pre-post cohort study using large pharmacy claims database included children (<16 years) with ≥2 consecutive asthma-controller prescriptions (2/1/99-1/31/00) and ≥1 anti-allergy prescription (within 3 months prior to initial controller prescription). Children on ICS and MON were matched 1:1 on age, days of prior AR therapy supply, duration of controller therapy and propensity score. Pre-post differences in mean per-member-per-month costs of rescue/acute medications [RAM] (short-acting beta agonist [SBA], antibiotics, oral corticosteroids [OCS]), prescription anti-allergy medications [AAM] (antihistamines, nasal steroids), and other respiratory medications [ORM] (xanthines, mast cell stabilizers, other anti-leukotrienes) were calculated. Results 1,236 of the 4,005 children were matched into ICS and MON groups (n=618 each). MON patients had a smaller cost increase overall compared to ICS group (combined cost for RAM, AAM and ORM: $5.55 vs $12.08, p=0.0003). Cost increase for RAM ($0.94 vs $3.82, p=0.0026) was significantly lower in MON group, driven by smaller increases in costs for SBA ($1.79 vs $3.34, p=0.008). Antibiotics (−$0.65 vs $0.51, p=0.1) and OCS (−0.20 vs −0.04, p=0.1) costs decreased in MON group. Cost increase for AAM ($5.29 vs $10.06, p<0.0001) was also significantly lower in MON group with both antihistamines ($4.44 vs 7.43, p=0.0037) and nasal steroids ($0.85 vs $2.63, p<0.0001) contributing. Mean cost of ORM decreased in both groups. Conclusions Among asthmatic children with AR, initiating MON resulted in lower costs of asthma-rescue and anti-allergy medications compared with initiating ICS.