Cost effectiveness of leukotriene modifiers in adults with asthma.

Full Abstract

Asthma is the most common chronic disorder in industrialised nations, with over 100 million people worldwide affected. Leukotrienes are chemical mediators released from mast cells, eosinophils and basophils. They cause bronchoconstriction, an increase in mucous secretions and activation of inflammatory cells. Leukotriene modifiers are a long-term controller medication used to treat asthma. They function by selectively competing for the leukotriene receptor sites, thereby blocking their action, or by inhibiting 5-lipoxygenase and thus preventing leukotriene formation. Both current US and Global Initiative for Asthma treatment guidelines have clarified the role of leukotriene modifiers in the management of asthma in adults and children. Leukotriene modifiers have two distinct roles:
to replace inhaled corticosteroids in milder asthma and as an add-on therapy to inhaled corticosteroids in more severe asthma.While efficacy is certainly an important issue, economic considerations are also important in a disease such as asthma where there are a variety of treatment options and the severity of the disease varies widely. This review examined published studies to better understand the cost effectiveness of leukotriene modifiers in adults with asthma. Fifteen articles were found that analysed the cost effectiveness of leukotriene modifiers, with almost all performed in the US. The vast majority of the studies were retrospective claims analyses, but three randomised controlled trials incorporating economic outcomes have been reported. The majority of the articles found that for both monotherapy in mild persistent asthma and add-on therapy in moderate persistent asthma, leukotriene modifiers were less cost effective than inhaled corticosteroids with or without a long-acting beta2-adrenoceptor agonist. However, these results must be viewed cautiously as in several studies there were methodological issues such as comparisons of unequal treatment groups or inappropriate use of leukotriene modifiers in stepwise treatment.

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Author information

Author/s: Heaton, Pamela C (PC);

Affiliation: Division of Pharmacy Practice, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267-0004, USA. Pam.Heaton(-atsign-)uc.edu

Journal and publication information

Publication Type: Journal Article; Review

Journal: PharmacoEconomics (Pharmacoeconomics), published in New Zealand. (Language: eng)

Reference: 2006-; vol 24 (issue 8) : pp 727-42

Dates: Created 2006/08/10; Completed 2006/10/26; Revised 2007/11/15;

PMID: 16898844, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Clinical Trials as Topic

Cost-Benefit Analysis
Drug Costs
Humans
Leukotriene Antagonists - economics; therapeutic use

Associated Chemicals: Anti-Asthmatic Agents (0) ; Leukotriene Antagonists (0)

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