מתוך medicontext.co.il
By David Douglas
NEW YORK (Reuters Health) – The use of inhaled fluticasone propionate, rather than of bronchodilators alone, is cost effective in the treatment of preschoolers with asthma, according to researchers in Denmark and the UK.
The lower overall asthma management expenditure thus achieved, lead researcher Dr. Hans Bisgaard told Reuters Health, is "primarily the result of a lower proportion of patients experiencing asthma exacerbations, which are costly to the healthcare system."
Dr. Bisgaard, of Copenhagen University Hospital, and colleagues conducted a retrospective review of data obtained during a 12-week study of 237 children between 12 and 47 months old. All of the subjects had recurrent wheeze or asthma symptoms. The children had been randomized to placebo or daily treatment with 100 or 200 mcg of fluticasone via a metered dose inhaler with a spacer.
In the fluticasone 100 mcg group, differences from placebo, although showing a favorable trend, were not significant. However, significantly more patients given the higher dose of fluticasone (73.7%) were exacerbation-free than were placebo patients (59.8%). Also 57.9% of fluticasone 200 mcg patients showed an improvement of 25% or more in cough symptoms versus 39.0% of placebo patients.
Costs per exacerbation-free patient, per symptom-free day, and per patient with a 25% or greater improvement in cough or wheeze symptoms were lower in the fluticasone groups than in the placebo group.
Furthermore, total healthcare costs per patient per day were lower in the fluticasone groups. Fluticasone costs "were more than offset by lower costs for hospital contacts and general practitioner visits."
There were six emergency department visits by placebo patients versus none by those in the active treatment groups. In addition, placebo patients made twice as many general practitioner visits than did those in the fluticasone 200 mcg group.
The researchers, whose findings appear in the December 2001 issue of Chest, conclude that from the perspective of the Danish healthcare system, such use of fluticasone 200 mcg daily "is a well-tolerated, cost-effective management strategy."
In an accompanying editorial, Canadian researcher Dr. R. Andrew McIvor, of Halifax, Nova Scotia, agrees, pointing out that, "in essence, by achieving asthma control, direct and indirect medical costs can be substantially reduced."
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