Reports From the Field: Most effective asthma drug not most often prescribed

Insurance claims analyzed

The most effective and intensive medication treatment for asthma is not the drug most commonly prescribed for the condition, a new study has found.

Researchers at Ohio State University (OSU) analyzed 18 months of insurance claims for asthma medications and concluded that the most effective of the medications cost two to three times less than the more frequently prescribed medications.

Results of the study, sponsored by Glaxo-SmithKline as part of an internship project in pharmacoeconomics at OSU, was published in the April issue of Pharmacotherapy.1

Patients who take the asthma drug fluticasone propionate (sold under the brand name Flovent) had fewer hospitalizations, fewer trips to the emergency department, and needed less medication to help control the symptoms than patients taking two other drugs, the researchers concluded.

Fluticasone propionate, an inhaled cortiosteroid, was compared to montelukast (Singulair) and zafirlukast (Accolate). The other two drugs are leukotriene receptor blockers in tablet form that help decrease the inflammation.

"These findings confirm what clinical trials have already shown. While doctors have to decide what’s best for their patients, we’re not sure why, given its effectiveness, fluticasone propionate is not prescribed more often as the first step in treating mild asthma," says Dev Pathak, DBA, study co-author and professor of pharmacy at OSU.

The researchers collected claims data from 781 patients covered by four nationwide managed care plans. The average cost for patients using fluticasone propionate was $528 for nine months. For patients using montelukast, the cost was $967.

For zafirlukast it was $1,359. Costs include filling prescriptions, trips to physicians’ offices and emergency departments, hospitalizations, and prescriptions for additional medicine for asthma symptoms.

Reference

1. Pathak D; Davis A, Stanford R. Economic Impact of Asthma Therapy with Fluticasone Propionate, Montelukast or Zafirlukast in a Managed Care Population. Pharmacotherapy:2002; 22:166-174..

Reports From the Field: Experienced hospitals a better choice for seniors’ surgery

Death rates lower at high-volume hospitals

Older patients who face high-risk surgery, such as cardiovascular or cancer operations, are more likely to survive if they go to a hospital that is highly experienced with their particular procedure, according to a new study.

The research, sponsored by the Agency for Healthcare Research and Quality (AHRQ) compared elderly patients who had any of 14 high-risk operations in hospitals that performed a high volume of the procedure with those at a hospital where only a few of the procedures were informed.

Each year, more than 20,000 elderly patients die undergoing one of the high-risk operations studied. More than 1,000 of these death could be averted if the patients at the lowest volume hospitals had surgery at the higher volume hospitals, concluded John D. Birkmeyer, MD, associated professor of surgery at Dartmouth Medical School in Hanover, NH, and a general surgeon at Dartmouth-Hitchcock Medical Center, lead researcher for the study.

The differences were most dramatic for patients undergoing surgery for cancer of the pancreas. Only 4% of patient at the highest- volume hospitals died compared to 16% at the lowest volume hospitals. Death rates for patients having surgery for cancer of the esophagus were 8% at the highest volume hospitals compared to 20% at the lowest volume ones.

Death rates were between 2% and 5% lower at high-volume hospitals for patients undergoing heart valve replacement, abdominal aneurysm repair, and surgery for lung, stomach, or bladder cancer.

The researchers concluded that hospital volume was less important for patients undergoing coronary artery surgery, carotid endarterectomy, and surgery for colon or kidney cancer.

The study examined outcomes in 2.5 million Medicare patients who had surgery between 1994 and 1991 and focused on total hospital volume, not Medicare volume.

Related article:

• Birkmeyer J, Siewers A, Finlayson E, et al: Hospital Volume and Surgical Mortality in the United States. NEJM, 2002; 346:1,128-1,137.