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Healthcare Utilisation and Costs Associated with Adding Montelukast to Current Therapy in Patients with Mild to Moderate Asthma and Co-Morbid Allergic Rhinitis

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Abstract

Objective: To evaluate the healthcare resource use and costs associated with adding montelukast to therapy in patients with mild to moderate persistent asthma and co-morbid seasonal allergic rhinitis whose asthma is inadequately controlled by their current asthma therapy.

Methods: A multicentre, pre-post retrospective cohort study was conducted in three European countries (Italy, Poland and Spain). Consecutive patients who were receiving inhaled corticosteroid therapy (monotherapy or combination therapy with long-acting ß2-adrenoceptor agonists) and who started concomitant treatment with montelukast between January 1999 and December 2002 were identified from clinical charts. Asthma/seasonal allergic rhinitis-related concomitant medications and asthma-related outpatient care, ED visits and hospitalisations for the periods 12 months before and 12 months after montelukast initiation were recorded from patient charts and combined with country-specific published unit costs (adjusted to 2004 values). The analysis was performed from a third-party-payer perspective and thus direct healthcare resource utilisation due to asthma/seasonal allergic rhinitis and associated costs for each country were estimated.

Results: A total of 98 physicians provided data for 696 asthmatic patients with seasonal allergic rhinitis (Italy: n = 158; Poland: n = 334; and Spain: n = 204). The mean age of patients was 32.7 years, 57.5% were female and patients had asthma that was considered either mild-persistent (54.5%) or moderate-persistent (45.5%) according to the Global Initiative for Asthma classifications. The introduction of montelukast (10 mg/day daily cost range €0.8–1.68) was associated with increases in the total annual mean healthcare cost per patient of 11.9%, 60.4% and 5.5% for Italy, Poland and Spain, respectively. However, mean annual costs for asthma-related outpatient care, ED visits and hospitalisations dropped significant ly in all three countries (Italy: from €805.00 to €281.60 [p < 0.01]; Poland: from €127.10 to €99.00 [p < 0.01]; and Spain: from €463.40 to €119.70 [p < 0.01]).

Conclusions:The addition of montelukast to therapy in patients with mild to moderate asthma and concomitant seasonal allergic rhinitis whose asthma was inadequately controlled by current asthma therapy significantly reduced the use of concomitant asthma-allergy medications, ED visits, outpatient care visits and hospitalisation. The total direct healthcare cost obtained after the addition of montelukast increased only as a result of the montelukast treatment cost.

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Acknowledgements

The study was financially supported by an unrestricted grant from Merck & Co., Inc., to Health Outcomes Research Europe (known as IMS Health since November 2006) and an independent contract research organisation. Dr Badia has received honoraria from Merck & Co., Inc. Dr Kocevar is a full-time employee of Merck & Co., Inc. Drs Dal Negro, Piskorz and Vives have no conflicts of interest that are directly relevant to the contents of this study.

Special thanks to Dr Larry Radican, Dr Don Yin, Dr Peter Polos and Bryan Rafalko for their valuable contribution in improving the study design.

Investigators in Poland: Prof. Piotr Kuna, Prof. Marek Kowalski, Prof. Krzysztof Buczylko, Prof. Jerzy Liephart, Dr Ewa Bogacka, Prof. Barbara Rogala, Dr Malgorzata Repin-Roszkouzca, Dr Grzegorz Mincewicz, Dr Ewa Trebas-Pietras, Dr Grzegorz Bzdon, Dr Jaroslaw Zieba, Dr Tomasz Kachel, Dr Irena Markiewicz-Bendkowska, Dr Cezary Rybacki, Dr Slawomir Garbicz, Dr Andrzej Dymerk, Dr Marek Pelc, Dr Janusz Grzona, Prof. Jerzy Kozielski, Dr Elzbieta Luczak, Dr Anna Ridlyk-Chwedczuk, Dr Wlodzimierz Mierzwa, Dr Dorota Laszczak, Dr Andrzej Szczerbowski, Dr Marta Kocik-Buczek, Dr Barbara Urbanowska, Dr Magdalena Napora-Grabowska, Dr Marzena Gajewska, Dr Irena Wojciechowska, Dr Kataryna Malinowska, Dr Justyna Pudelko, Dr Piotr Piskosz, Dr Anna Rogalewska, Dr Anna Ploszczuk.

Investigators in Italy: Prof. Roberto Dal Negro, Prof. Nunzio Crimi, Prof. Pierluigi Paggiaro, Prof. Stefano Centanni, Prof. Antonio Spanevello, Prof. Gennaro d’Amato, Dr Paolo Minuti, Dr Manlio Milanese, Prof. Piero Maestrelli, Dr Marco Bonavia, Prof. Giuseppe Girbino, Prof. Vito Brusasco, Prof. Emmanuele Crimi, Dr Gianna Moscato.

Investigators in Spain: Dr Amparo Picó Peris, Dr Mercedes Cimarra Álvarez, Dr Lluís Marqués Amat, Dr Josep Lluís Montserrat Carrio, Dr Alfons Malet Casajuana, Dr Teresa Robledo Echarren, Dr Joaquín Quiralte Enriquez, Dr Xavier Clar Guevara, Dr Teresa Revilla Lorenzo, Dr Sebastià Aguiló i Moll, Dr Miguel Angel Fuentes Perez, Dr Cristina Aguado Taberné, Dr Alfonso Nuñez Cirera, Dr Araceli Griñó Guimerà, Dr José María Jiménez Herrera, Dr Alejandro Carbonero Martínez, Dr Franklin Romero Hernández, Dr Mercedes Rodríguez Franco, Dr Javier Antón Ortega, Dr Jose Antonio Pérez Lorente, Dr Jose Rodríguez Inchaustegui, Dr Enrique Mora Requena, Dr Rafa Alonso Matía, Dr Milko Torres Castro, Dr Francisco Duran Sánchez, Dr Marcelino Camino Benito, Dr Salvador Aguilar Pérez, Dr Raquel Blasco Redondo, Dr María Pía de Miguel Márquez, Dr José Maria Orriols Moix, Dr Pedro Barba Gálvez, Dr Belén Iglesias Francesch, Dr Fernando Saavedra Pita, Dr Ramón Vives Conesa, Ma Luz Díez Gómez, Dr Luís Angel Navarro Seisdedos, Dr Alejandro Sánchez Alonso, Dr Isabel Molero Sánchez, Dr Rosa Ma Perelló Servera, Dr José Carlos Orta Cuevas, Dr Ignacio Antépara Ercoreca, Dr Mercedes Hernández Gómez, Dr Teresa Carrillo Díaz, Dr Teresa Dordal Culla, Dr Ester Pinto Nogués, Dr Montserrant Molina Gorina, Dr Juan Fraj Lázaro, Dr José Antonio Pinto Blázquez, Dr Margarita Marín, Dr Josep Lluis Heredia Budó.

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Authors and Affiliations

  1. Lung Department, Bussolengo General Hospital, Verona, Italy

    Roberto Dal Negro

  2. Pneumology Department, Outpatient Clinic, Wotomin, Poland

    Peter Piskorz

  3. Allergology Department, Hospital 12 Octubre, Madrid, Spain

    Roberto Vives

  4. IMS Health (known as Health Outcomes Research Europe prior to November 2006), c/Dr. Ferran, 25, 2°, Barcelona, 08034, Spain

    Magda Guilera &  Xavier Badia

  5. Outcomes Research, Merck & Co., Inc., Whitehouse Station, New Jersey, USA

    Vasilisa Sazonov Kocevar

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  1. Roberto Dal Negro
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  2. Peter Piskorz
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  4. Magda Guilera
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  5. Vasilisa Sazonov Kocevar
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  6. Xavier Badia
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Correspondence to Xavier Badia.

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Dal Negro, R., Piskorz, P., Vives, R. et al. Healthcare Utilisation and Costs Associated with Adding Montelukast to Current Therapy in Patients with Mild to Moderate Asthma and Co-Morbid Allergic Rhinitis. Pharmacoeconomics 25, 665–676 (2007). https://doi.org/10.2165/00019053-200725080-00004

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